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

Challenges

Currently, NICUs across the country have begun to introduce cerebral oximeters to measure cerebral oxygenation levels. Although there has been an explosion of research with premature infants using NIRS to measure cerebral oxygenation, normative values for cerebral oxygenation measurements at each postmenstrual or postnatal age are not available for premature infants. Current values for the first day of life come from two studies, 55.1% to 96.4%[76] and 67.7% to 82.1%,[75] respectively. Although these values provide a good starting point, narrower ranges taking into account age and time beyond the first day of life are necessary. In addition to normative values, percentage of change or thresholds may also need to be determined to identify impending neurologic injury.[57] Care decisions and the assessment of infants at higher risk for IVH and PVL will remain unknown until normative values are better established for each cerebral oximeter. Therefore, further research to establish normal cerebral oxygenation ranges needs to be examined longitudinally to capture the development of cerebral oxygenation as premature infants mature.

Current vital signs of heart rate, respiratory rate, peripheral oxygenation, and blood pressure may indicate cerebral blood flow and the brain's receipt of oxygen-rich blood.[77,78] Although cerebral oxygenation may be a more sensitive indicator of reduced blood flow to the brain, in-depth evaluation is necessary to compare current vital signs with cerebral oxygenation. Before neonatal practice decides to add another probe to the bodies of these tiny humans, its imperative that the science establishes certain cause for the addition of another monitored vital sign. Future research will need to determine that cerebral oxygenation values are not embedded or apparent in currently monitored vital signs. As a result, before cerebral oxygenation becomes a new vital sign, examination in comparison with currently measured vital signs is needed.

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