ABSTRACT
BACKGROUND: There is a strong need for continuous cerebral circulation monitoring in neonatal care, since suboptimal cerebral blood flow may lead to brain injuries in preterm infants and other critically ill neonates. NeoDoppler is a novel ultrasound system, which can be gently fixed to the anterior fontanel and measure cerebral blood flow velocity continuously in different depths of the brain simultaneously. We aimed to study the feasibility, accuracy, and potential clinical applications of NeoDoppler in preterm infants and sick neonates. METHOD: Twenty-five infants born at different gestational ages with a variety of diagnoses on admission were included. The probe was placed over the anterior fontanel, and blood flow velocity data were continuously recorded. To validate NeoDoppler, we compared the measurements with conventional ultrasound; agreement was assessed using Bland-Altman plots. RESULTS: NeoDoppler can provide accurate and continuous data on cerebral blood flow velocity in several depths simultaneously. Limits of agreement between the measurements obtained with the two methods were acceptable. CONCLUSION: By monitoring the cerebral circulation continuously, increased knowledge of cerebral hemodynamics in preterm infants and sick neonates may be acquired. Improved monitoring of these vulnerable brains during a very sensitive period of brain development may contribute toward preventing brain injuries.
Subject(s)
Cerebrovascular Circulation , Hemodynamic Monitoring , Hemodynamics , Infant, Newborn, Diseases/diagnosis , Laser-Doppler Flowmetry , Ultrasonography, Doppler, Transcranial , Blood Flow Velocity , Feasibility Studies , Female , Gestational Age , Humans , Infant, Newborn , Infant, Newborn, Diseases/physiopathology , Infant, Premature , Male , Predictive Value of Tests , Reproducibility of Results , Time FactorsABSTRACT
AIM: This Norwegian study explored whether administering surfactant without intubation (SWI) delayed the need for early mechanical ventilation and reduced respiratory and nonrespiratory complications in infants born before 32 weeks of gestational age. METHODS: We compared 262 infants admitted to a level-three neonatal intensive care unit: 134 born before the introduction of SWI on 1 December 2011 were in the control group and 128 infants born after this date were in the study group. RESULTS: The proportion of infants treated with surfactant did not differ between the groups, but mechanical ventilation before 72 hours of life was lower in the study group than the control group, with an odds ratio (OR) of 0.58 and a 95% confidence interval (CI) of 0.35-0.96. Fewer study group infants needed supplemental oxygen at 28 days of life. One study infant and nine control infants had intraventricular haemorrhage grades 3-4 and, or, cystic periventricular leukomalacia (OR 0.10, 95% CI 0.01-0.83). These results were strengthened in analyses restricted to surfactant-treated infants and the proportion needing supplemental oxygen at 36 weeks was reduced. CONCLUSION: Surfactant without intubation reduced the need for early mechanical ventilation and major brain injuries in infants born at <32 weeks of gestation.
