Cerebral Oxygenation Monitoring

A Strategy to Detect Intraventricular Hemorrhage and Periventricular Leukomalacia

Heather E. Elser, MSN, RN, NNP-BC, CNS, PhD Student; Diane Holditch-Davis, PhD, RN, FAAN; Debra H. Brandon, PhD, RN, CCNS, FAAN

Disclosures

NAINR. 2011;11(3):153-159. 

In This Article

Abstract and Introduction

Abstract

Premature infants are at risk for intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL), theorized to be a result from fluctuations in cerebral blood flow. Monitoring cerebral oxygenation offers a method to observe changes in cerebral blood flow that may be beneficial for detecting and preventing IVH and PVL. This article explains the potential for cerebral oxygenation monitoring in detecting IVH and PVL using cerebral oximetry, reviews current knowledge known about cerebral oxygenation, and describes current challenges for cerebral oxygenation to be the next neuroprotective vital sign.

Introduction

Every year, approximately 500 000 infants are born prematurely in the United States.[1] Advances in technology have increased premature infants' chances of survival and subsequent discharge from the hospital to home. However, as many as 50% of premature infants go home with neurologic deficits[2] related to prematurity that result in motor impairments and learning disabilities.[3–6] As compared with their full-term counterparts, premature infants are at increased risk for these neurologic complications because of the immaturity of their nervous system and its undeveloped cerebrovascular control.[5,7–9] Prevention of neurologic complications could promote neurodevelopment comparable with the full-term infant.

Intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL) are two prevalent neurologic complications in premature infants resulting from fluctuations in cerebral blood flow and cerebral ischemic episodes, respectively. To detect and prevent IVH or PVL, a continuous method to monitor the premature infants' nervous system via cerebral blood flow is necessary. Cerebral oxygenation is a potential biomarker to assess an infant's nervous system that can be monitored using cerebral oximetry. Cerebral oxygenation is the amount of oxygen present in arteries, veins, and capillaries of the brain.[10] Because cerebral blood flow is the mechanism by which oxygen is delivered to the brain, then measuring cerebral oxygenation offers a method to observe changes in cerebral blood flow. Thus, preferred over invasive methods, cerebral oxygenation monitoring would provide neuroprotection at the bedside to observe and potentially detect in real time the development of IVH and PVL. The aim of this article is to explain the potential for cerebral oxygenation monitoring in detecting IVH and PVL using cerebral oximetry, review current knowledge known about cerebral oxygenation, and describe current challenges for cerebral oxygenation to be the next neuroprotective vital sign.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....