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Karger Publishers, Neonatology, 4(117), p. 504-512, 2020

DOI: 10.1159/000508961

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Combined Multimodal Cerebral Monitoring and Focused Hemodynamic Assessment in the First 72 h in Extremely Low Gestational Age Infants

This paper was not found in any repository, but could be made available legally by the author.
This paper was not found in any repository, but could be made available legally by the author.

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Abstract

<b><i>Background:</i></b> Characteristic changes in cerebral saturation (CrSO<sub>2</sub>), amplitude-integrated electroencephalography (aEEG), and echocardiography (ECHO) may be associated with intraventricular hemorrhage (IVH); however, the feasibility of their combined application is not known. <b><i>Objective:</i></b> The aim of this work was to investigate the feasibility and safety of combined multimodal cerebral and hemodynamic monitoring in extremely low gestational age (ELGA) infants in the first 72 h after birth. <b><i>Methods:</i></b> In this prospective ­observational study of 50 infants born between 23 + 0 and 27 + 6 weeks gestation, we measured CrSO<sub>2</sub> and aEEG, starting &#x3c;8 h until 72 h of age. Sequential echocardiography and head ultrasound were performed at 4–8, 12–18, 24–30, and 48–60 h of age. The primary outcome was feasibility of multimodal monitoring, defined as &#x3e;75% of the subjects satisfying at least 3/4 criteria: (a) CrSO<sub>2</sub> and (b) aEEG monitoring each for &#x3e;75% of the time, and (c) at least 2 out of 4 ECHO and (d) head ultrasounds (at least one by age 24 h). Adverse reactions to sensors, desaturation, and bradycardia during ultrasound studies were recorded. <b><i>Results:</i></b> Fifty infants were enrolled over 14 months. Multimodal monitoring was feasible in 49 (98%) infants. Forty-one (82%) infants fulfilled all 4 criteria. Mild erythema below CrSO<sub>2</sub> sensors lasting 3–8 h without skin breakdown was noted in 8/50 subjects (16%). Desaturation was noted during 17/197 (8.6%) of the ultrasound studies. In total, 26/50 (52%) infants developed IVH (grade I/II, <i>n</i> = 22; grade III/IV, <i>n</i> = 4). <b><i>Conclusion:</i></b> Multimodal monitoring is feasible, safe, and well tolerated in ELGA infants in the first 72 h after birth.