A pilot feasibility study to assess and validate the use of cerebral saturation monitoring during the transport of critically ill neonates
Creators: name: Fowler, Natalie
name: Dady, Ian
Publisher: name: F1000 Research Limited
Year: 2018

description: Background: Neonates are highly susceptible to frequent apneic or hypoventilatory episodes due to under developed lungs and lack of mature respiratory control. If left untreated, hypoxic episodes can lead to clinical complications; cardiovascular issues and neurological deficits e.g. hypoxic-ischemic encephalopathy. Oxygen toxicity is also a pertinent issue. Since the 1940s, research has linked supplemental oxygen exposure and a clinical condition now known as Retinopathy of Prematurity (ROP); where abnormalities of the blood vessels within the retina cause detachment and blindness. Research continues to document this associated link and it is firmly understood that infants exposed to episodes of hyperoxemia are at increased risk from developing ROP and this should be avoided. These conditions all impact significantly on the child’s quality of life. The severity of these clinical conditions that can arise from varying degrees of oxygen therapy provide a strong case for optimum oxygen control and extensive monitoring to provide consistent feedback, particularly throughout neonatal care. One specific area of neonatal care where oxygen monitoring is significantly reduced due to practicality is during transport where clinicians currently rely on pulse oximetry alone.<br>Aim: To assess the feasibility and practicality of cerebral saturation monitoring during neonatal transfer, and to analyse the effect of transportation on trend values.<br>Methods: This study looked at cerebral saturations (rSO2) measured by the INVOS 5100C during non-emergency transfers of neonates with no significant respiratory or cardiovascular conditions and assessed the practicality of this monitor, as well as observing and documenting vital sign data before, during and after transfer for comparison.<br>Results: 4 patients consented and were recruited into this study. The cerebral saturations monitor was safe and secure during transfer and continuously measured throughout movement. Average cerebral saturations readings were found to be between 52% -95%. The average baseline as determined by the INVOS 5100C was 78.75. Participants who were wearing hats had better continuous data collection due to the sensor being affected by excessive light conditions. During one transfer the rSO2 measurement reflected a profound desaturation and apnoea. When analysing vital sign data there was no statistically significant difference in vital sign trends during transfer compared to when stationary in the 4 recruited (heart rate p= 0.286, respiratory rate p= 0.068, SpO2 p= 0.126). There was no statistically significant difference between rSO2 when stationary and when moving (p = 0.344 and when normalised p = 0.392).<br>Conclusions: Cerebral saturations monitoring is feasible and practical during neonatal transfer. More data is required to analyse correlation of saturations and the prediction of clinical events however this initial study suggests potential of a useful, informative addition to transfers. Due to the limited number of participants, it is not possible to draw any statistically significant conclusions, therefore further studies with better recruited are needed to explore these initial findings.