Non-invasive Optoacoustic Monitoring of Neonatal Cerebral Venous Oxygen Saturation
Herrmann, Stephen A
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Peripartum asphyxia is a common cause of cerebral hypoxia and when severe can lead to neuronal injury and hypoxic-ischemic encephalopathy (HIE) in the newborn. HIE has been reported up to 3/1000 live births with a high mortality of up to 50% and 25% of survivors developing permanent neurological disabilities. Cerebral hypoxia in neonates is a diagnostic challenge due to a combination of poor correlation between hypoxia severity and physical exam findings, as well as a lack of methodology to quickly and accurately measure cerebral venous oxygen saturation. While diagnosis of neonatal cerebral hypoxia is limited, treatment with cerebral hypothermia has shown to decrease both mortality and long-term neurodevelopmental disabilities in neonates with moderate to severe cerebral hypoxia. Clinicians are still in need of timely and accurate tests to diagnose cerebral hypoxia prior to treatment. Invasive internal jugular (IJ) catheters can provide an assessment of cerebral hypoxia with poor clinical outcomes seen once saturation is below 50%, but this method of assessment is not practical for routine screening use in a neonate due to risks and procedure complications. A non-invasive measurement of cerebral venous oxygen saturation could diagnose cerebral hypoxia earlier and help stratify neonates at risk to further improve clinical outcomes. Our project objective is to evaluate a laser optoacoustic device for non-invasive monitoring of cerebral venous oxygen saturation through the open anterior/posterior fontanelles in neonates. Sheep models have shown this device can accurately measure cerebral venous oxygen saturation. We initially evaluated our laser optoacoustic system using plastisol phantoms of the neonate superior sagittal sinus, and then obtained measurements from clinically stable neonates in the UTMB neonatal intensive care unit. Analysis of these neonates provided initial data on the range of cerebral venous oxygen saturation levels in clinically stable neonates. The ultimate goal of this work is to identify a device that can quickly and accurately diagnose neonates at risk for cerebral hypoxia and in turn improve mortality and neurological disabilities in these at-risk patients.