Peripheral muscle fractional tissue oxygen extraction in stable term and preterm neonates during the first 24 h after birth

Abstract

Background: Peripheral muscle fractional tissue oxygen extraction (pFTOE) represents the relative extraction of oxygen from the arterial to venous compartment, providing information about dynamic changes of oxygen delivery and oxygen consumption. The aim of the present study was to establish reference values of pFTOE during the first 24 h after birth in stable term and late preterm neonates.

Methods: The present study is a post-hoc analysis of secondary outcome parameters of prospective observational studies. Only stable neonates without infection, asphyxia and any medical support were eligible for our analysis to obtain normal values. For measurements of peripheral muscle tissue oxygenation index (pTOI) during the first 24 h after birth in term and preterm neonates, the NIRO200/NIRO200NX was used. Arterial oxygen saturation (SpO₂) was obtained by pulse oximetry. pFTOE was calculated out of pTOI and SpO₂: pFTOE = (SpO₂-pTOI)/SpO₂. Measurements of neonates were stratified into four groups according to their respective measurement time point (6 h periods) after birth. Term and preterm neonates were analyzed separately. Mean values of measurements during the first time period (0-6 h after birth) were compared to measurements of the following time periods (second = 7-12 h, third = 13-18 h, fourth = 19-24 h after birth).

Results: Two-hundred-fourty neonates (55 term and 185 late preterm neonates) had at least one peripheral muscle NIRS measurements within the first 24 h after birth. Mean gestational age and birth weight were 39.4 ± 1.1 weeks and 3360 (2860-3680)g in term neonates and 34.0 ± 1.4 weeks and 2060 (1750-2350)g in preterm neonates, respectively. In term neonates pFTOE was 0.264 (0.229-0.300), 0.228 (0.192-0.264), 0.237 (0.200-0.274) and 0.220 (0.186-0.254) in the first, second, third and fourth time period. In preterm neonates pFTOE was 0.229 (0.213-0.246), 0.225 (0.209-0.240), 0.226 (0.210-0.242) and 0.238 (0.222-0.255) in the first, second, third and fourth time period. pFTOE did not show any significant changes between the time periods, neither in term nor in preterm neonates.

Conclusion: We provide reference values of pFTOE for stable term and late preterm neonates within the first 24 h after birth, which were stable when comparing four 6-h periods. These normal values are of great need for interpreting pFTOE in scientific context as well as for potential future clinical applications.

Keywords: muscle oxygenation; near-infrared spectroscopy; neonate; pFTOE; reference values.

Figure 1

Study flow chart of term and preterm neonates with pFTOE measurements after admission to the neonatal intensive care unit during the first 24 h after birth.

Figure 2

pFTOE measured with NIRS in stable term and preterm neonates during the first 24 h after birth, grouped in “6 h time periods” (“0–6 h”, “7–12 h”, “13–18 h”, “19–24 h”). Term neonates are displayed in green blots and preterm neonates in yellow blots. Values are presented as median (IQR).

Figure 3

pTOI measured with NIRS in stable term and preterm neonates during the first 24 h after birth, grouped in “6 h time periods” (“0–6 h”, “7–12 h”, “13–18 h”, “19–24 h”). Term neonates are displayed in green blots and preterm neonates in yellow blots. Values are presented as median (IQR).