Cerebral near infrared spectroscopy oximetry in extremely preterm infants: phase II randomised clinical trial
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OBJECTIVE: To determine if it is possible to stabilise the cerebral oxygenation of extremely preterm infants monitored by cerebral near infrared spectroscopy (NIRS) oximetry.
DESIGN: Phase II randomised, single blinded, parallel clinical trial.
SETTING: Eight tertiary neonatal intensive care units in eight European countries.
PARTICIPANTS: 166 extremely preterm infants born before 28 weeks of gestation: 86 were randomised to cerebral NIRS monitoring and 80 to blinded NIRS monitoring. The only exclusion criterion was a decision not to provide life support.
INTERVENTIONS: Monitoring of cerebral oxygenation using NIRS in combination with a dedicated treatment guideline during the first 72 hours of life (experimental) compared with blinded NIRS oxygenation monitoring with standard care (control).
MAIN OUTCOME MEASURES: The primary outcome measure was the time spent outside the target range of 55-85% for cerebral oxygenation multiplied by the mean absolute deviation, expressed in %hours (burden of hypoxia and hyperoxia). One hour with an oxygenation of 50% gives 5%hours of hypoxia. Secondary outcomes were all cause mortality at term equivalent age and a brain injury score assessed by cerebral ultrasonography.
RANDOMISATION: Allocation sequence 1:1 with block sizes 4 and 6 in random order concealed for the investigators. The allocation was stratified for gestational age (<26 weeks or ≥ 26 weeks).
BLINDING: Cerebral oxygenation measurements were blinded in the control group. All outcome assessors were blinded to group allocation.
RESULTS: The 86 infants randomised to the NIRS group had a median burden of hypoxia and hyperoxia of 36.1%hours (interquartile range 9.2-79.5%hours) compared with 81.3 (38.5-181.3) %hours in the control group, a reduction of 58% (95% confidence interval 35% to 73%, P<0.001). In the experimental group the median burden of hypoxia was 16.6 (interquartile range 5.4-68.1) %hours, compared with 53.6 (17.4-171.3) %hours in the control group (P=0.0012). The median burden of hyperoxia was similar between the groups: 1.2 (interquartile range 0.3-9.6) %hours in the experimental group compared with 1.1 (0.1-23.4) %hours in the control group (P=0.98). We found no statistically significant differences between the two groups at term corrected age. No severe adverse reactions were associated with the device.
CONCLUSIONS: Cerebral oxygenation was stabilised in extremely preterm infants using a dedicated treatment guideline in combination with cerebral NIRS monitoring.Trial registration ClinicalTrial.gov NCT01590316.
Original language | English |
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Article number | g7635 |
Journal | B M J (Online) |
Volume | 350 |
Pages (from-to) | 1-11 |
Number of pages | 11 |
ISSN | 1756-1833 |
Publication status | Published - Jan 2015 |
- Anoxia, Brain, Cerebrovascular Circulation, Clinical Protocols, Europe, Guideline Adherence, Humans, Infant, Extremely Premature, Infant, Newborn, Intensive Care Units, Neonatal, Intensive Care, Neonatal, Monitoring, Physiologic, Oximetry, Practice Guidelines as Topic, Spectroscopy, Near-Infrared, Time Factors, Treatment Outcome
Research areas
Links
- http://www.bmj.com/content/bmj/350/bmj.g7635.full.pdf
Final published version
ID: 162408259