A complication of intraventricular hemorrhage among preterm neonates is post-hemorrhagic ventricle dilation (PHVD), which is associated with a greater risk of life-long neurological disability. Clinical evidence, including suppressed EEG patterns, suggests that cerebral perfusion and oxygenation is impaired in these patients, likely due to elevated intracranial pressure (ICP). Cerebral blood flow (CBF) and the cerebral metabolic rate of oxygen (CMRO2) can be quantified by dynamic contrast-enhanced NIRS; however, PHVD poses a unique challenge to NIRS since the cerebral mantle can be compressed to 1 cm or less. The objectives of this work were to develop a finite-slab model for the analysis of NIRS spectra, incorporating depth measurements from ultrasound images, and to assess the magnitude of error when using the standard semi-infinite model. CBF, tissue saturation (StO2) and CMRO2 were measured in 9 patients receiving ventricle taps to reduce ICP. Monte Carlo simulations indicated that errors in StO2 could be greater than 20% if the cerebral mantle was reduced to 1 cm. Using the finite-slab model, basal CBF and CMRO2 in the PHVD patients were not significantly different from a control group of preterm infants (14.6 ± 4.2 ml/100 g/min and 1.0 ± 0.4 ml O2/100 g/min), but StO2 was significantly lower (PDA 70.5 ± 9%, PHVD 58.9 ± 12%). Additionally, ventricle tapping improved CBF by 15.6 ± 22%. This work indicates that applying NIRS to PHVD patients is prone to error; however, this issue can be overcome with the appropriate model and using readily available ultrasound images.
Dilation of the cerebral ventricles is a common condition in preterm neonates with intraventricular hemorrhage (IVH). This post hemorrhagic ventricle dilation (PHVD) can lead to lifelong neurological impairment through ischemic injury due to increased intracranial pressure (ICP). Interventions, such as ventricular tapping to remove cerebrospinal fluid (CSF), are used to prevent injury, but determining the optimal time for treatment is difficult as clinical signs of increased ICP lack sensitivity. There is a growing interest in using near-infrared spectroscopy (NIRS) because of its ability to monitor cerebral oxygen saturation (StO2) at the bedside. However, the accuracy of NIRS may be affected by signal contamination from enlarged ventricles, especially if there are blood breakdown products (bbp) in CSF following IVH. To investigate this, serial NIR spectra from the head and from CSF samples were acquired over a month from seven IVH patients undergoing treatment for PHVD. Over time, the visual appearance of the CSF samples progressed from dark brown (“tea color”) to clear yellow, reflecting the reduction in bbp concentration as confirmed by the stronger absorption around 760 nm at the earlier time points. All CSF samples contained strong absorption at 960 nm due to water. More importantly the same trend in these absorption features was observed in the in vivo spectra, and Monte Carlo simulations confirmed the potential for signal contamination from enlarged ventricles. These findings highlight the challenges of accurately measuring StO2 in this patient population and the necessity of using a hyperspectral NIRS system to resolve the additional chromophores.
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