Am J Perinatol
DOI: 10.1055/a-2253-8740
Original Article

Reference Ranges for Regional Cerebral Oxygen Saturation with Masimo O3® after Birth and Differences with Other Devices

1   Division of Neonatology, Department of Pediatrics, Rio Hortega Hospital, Valladolid, Spain
,
Sonia Caserío Carbonero
1   Division of Neonatology, Department of Pediatrics, Rio Hortega Hospital, Valladolid, Spain
› Author Affiliations
Funding None.

Abstract

Objective Cerebral oximetry using near-infrared spectroscopy (NIRS) is a noninvasive optical technology widely used in neonatology. The present study aimed to define reference ranges for cerebral tissue oxygen saturation (crSO2) with a new four-wavelength NIRS device, Masimo O3® oximeter, during immediate transition after birth and compare values with those obtained previously with NIRO 200NX®.

Study Design This was a prospective observational study using Masimo O3 device to measure crSO2 and regional cerebral fractional tissue oxygen extraction (cFTOE) in healthy term newborns delivered by primary cesarean section, during the 15 minutes after cord clamping. The neonates who required any medical support were excluded. The NIRS sensor was placed on the right forehead. Peripheral oxygen saturation and heart rate were continuously measured by pulse oximetry. Previous studies which established centiles for crSO2 with NIRO 200NX were used for comparison.

Results A total of 44 newborns were included. The median crSO2 and cFTOE (interquartile range) at 2, 5, and 7 minutes was 54% (49–54), 71% (64–86), and 79% (73–84) and 0,25 (0,18–0,33), 0,19 (0,15–0,23), and 0,16 (0,12–0,21), respectively, with no further changes afterwards. The crSO2 measurements were significantly higher with Masimo O3 compared with NIRO-200NX.

Conclusion The present observational study presented reference ranges for crSO2 and cFTOE measured with Masimo O3 oximeter during the immediate neonatal transition. Values obtained with O3 were higher than those obtained with other oximeters. For this reason, crSO2 is device-specific so there must be known reference values for each oximeter to define therapeutic interventions based on crSO2 and assess cerebral oxygenation in clinical studies.

Key Points

  • Masimo O3 uses four wavelengths to measure regional oxygen saturation value.

  • O3 values of crSO2 and cFTOE differ with other neonatal oximeters at birth.

  • Knowledge of reference range of O3 at birth is essential to guide resuscitation.



Publication History

Received: 23 October 2023

Accepted: 23 January 2024

Accepted Manuscript online:
25 January 2024

Article published online:
27 February 2024

© 2024. Thieme. All rights reserved.

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  • References

  • 1 Hummler H. Near-infrared spectroscopy for perfusion assessment and neonatal management. Semin Fetal Neonatal Med 2020; 25 (05) 101145
  • 2 Mittnacht AJ. Near infrared spectroscopy in children at high risk of low perfusion. Curr Opin Anaesthesiol 2010; 23 (03) 342-347
  • 3 Ghanayem NS, Wernovsky G, Hoffman GM. Near-infrared spectroscopy as a hemodynamic monitor in critical illness. Pediatr Crit Care Med 2011; 12 (4, suppl) S27-S32
  • 4 Jöbsis FF. Noninvasive, infrared monitoring of cerebral and myocardial oxygen sufficiency and circulatory parameters. Science 1977; 198 (4323) 1264-1267
  • 5 Barstow TJ. Understanding near infrared spectroscopy and its application to skeletal muscle research. J Appl Physiol 2019; 126 (05) 1360-1376
  • 6 Watzman HM, Kurth CD, Montenegro LM, Rome J, Steven JM, Nicolson SC. Arterial and venous contributions to near-infrared cerebral oximetry. Anesthesiology 2000; 93 (04) 947-953
  • 7 Wolf M, Greisen G. Advances in near-infrared spectroscopy to study the brain of the preterm and term neonate. Clin Perinatol 2009; 36 (04) 807-834 , vi
  • 8 Schneider A, Minnich B, Hofstätter E, Weisser C, Hattinger-Jürgenssen E, Wald M. Comparison of four near-infrared spectroscopy devices shows that they are only suitable for monitoring cerebral oxygenation trends in preterm infants. Acta Paediatr 2014; 103 (09) 934-938
  • 9 Farag MM, Khedr AAEAE, Attia MH, Ghazal HAE. Role of near-infrared spectroscopy in monitoring the clinical course of asphyxiated neonates treated with hypothermia. Am J Perinatol 2021; (e-pub ahead of print) DOI: 10.1055/s-0041-1740513.
  • 10 Bruckner M, Pichler G, Urlesberger B. NIRS in the fetal to neonatal transition and immediate postnatal period. Semin Fetal Neonatal Med 2020; 25 (02) 101079
  • 11 Masimo Corporation. O3® Regional Oximeter Operator's Manual. 2018 . Accessed October 20, 2023 at: https://techdocs.masimo.com/globalassets/techdocs/pdf/lab-9358c_master.pdf
  • 12 Pichler G, Binder C, Avian A, Beckenbach E, Schmölzer GM, Urlesberger B. Reference ranges for regional cerebral tissue oxygen saturation and fractional oxygen extraction in neonates during immediate transition after birth. J Pediatr 2013; 163 (06) 1558-1563
  • 13 Baik N, Urlesberger B, Schwaberger B. et al. Reference ranges for cerebral tissue oxygen saturation index in term neonates during immediate neonatal transition after birth. Neonatology 2015; 108 (04) 283-286
  • 14 Dullenkopf A, Kolarova A, Schulz G, Frey B, Baenziger O, Weiss M. Reproducibility of cerebral oxygenation measurement in neonates and infants in the clinical setting using the NIRO 300 oximeter. Pediatr Crit Care Med 2005; 6 (03) 344-347
  • 15 Cole TJ, Green PJ. Smoothing reference centile curves: the LMS method and penalized likelihood. Stat Med 1992; 11 (10) 1305-1319
  • 16 Pocivalnik M, Pichler G, Zotter H, Tax N, Müller W, Urlesberger B. Regional tissue oxygen saturation: comparability and reproducibility of different devices. J Biomed Opt 2011; 16 (05) 057004
  • 17 Dullenkopf A, Frey B, Baenziger O, Gerber A, Weiss M. Measurement of cerebral oxygenation state in anaesthetized children using the INVOS 5100 cerebral oximeter. Paediatr Anaesth 2003; 13 (05) 384-391
  • 18 Almaazmi M, Schmid MB, Havers S. et al. Cerebral near-infrared spectroscopy during transition of healthy term newborns. Neonatology 2013; 103 (04) 246-251
  • 19 Hessel TW, Hyttel-Sorensen S, Greisen G. Cerebral oxygenation after birth - a comparison of INVOS(®) and FORE-SIGHT™ near-infrared spectroscopy oximeters. Acta Paediatr 2014; 103 (05) 488-493
  • 20 Ferraris A, Jacquet-Lagrèze M, Fellahi JL. Four-wavelength near-infrared peripheral oximetry in cardiac surgery patients: a comparison between EQUANOX and O3. J Clin Monit Comput 2018; 32 (02) 253-259
  • 21 Urlesberger B, Grossauer K, Pocivalnik M, Avian A, Müller W, Pichler G. Regional oxygen saturation of the brain and peripheral tissue during birth transition of term infants. J Pediatr 2010; 157 (05) 740-744
  • 22 Binder C, Urlesberger B, Avian A, Pocivalnik M, Müller W, Pichler G. Cerebral and peripheral regional oxygen saturation during postnatal transition in preterm neonates. J Pediatr 2013; 163 (02) 394-399
  • 23 Pichler G, Schmölzer GM, Urlesberger B. Cerebral Tissue Oxygenation during Immediate Neonatal Transition and Resuscitation. Front Pediatr 2017; 5: 29
  • 24 Fauchère JC, Schulz G, Haensse D. et al. Near-infrared spectroscopy measurements of cerebral oxygenation in newborns during immediate postnatal adaptation. J Pediatr 2010; 156 (03) 372-376
  • 25 Lara-Cantón I, Badurdeen S, Dekker J. et al. Oxygen saturation and heart rate in healthy term and late preterm infants with delayed cord clamping. Pediatr Res 2022; (e-pub ahead of print) DOI: 10.1038/s41390-021-01805-y.
  • 26 Urlesberger B, Brandner A, Pocivalnik M, Koestenberger M, Morris N, Pichler G. A left-to-right shunt via the ductus arteriosus is associated with increased regional cerebral oxygen saturation during neonatal transition. Neonatology 2013; 103 (04) 259-263
  • 27 Schwaberger B, Pichler G, Binder-Heschl C, Baik N, Avian A, Urlesberger B. Transitional changes in cerebral blood volume at birth. Neonatology 2015; 108 (04) 253-258
  • 28 Noori S, Wlodaver A, Gottipati V, McCoy M, Schultz D, Escobedo M. Transitional changes in cardiac and cerebral hemodynamics in term neonates at birth. J Pediatr 2012; 160 (06) 943-948
  • 29 Matterberger C, Baik-Schneditz N, Schwaberger B. et al. Blood glucose and cerebral tissue oxygenation immediately after birth-an observational study. J Pediatr 2018; 200: 19-23
  • 30 Zhang W, Ge F, Lian C, Xia R, Zhang B. A single-center observational clinical study on factors associated with regional cerebral oxygen saturation in full-term newborn infants during birth transition. Med Sci Monit 2021; 27: e928750
  • 31 Tamussino A, Urlesberger B, Baik N. et al. Low cerebral activity and cerebral oxygenation during immediate transition in term neonates-A prospective observational study. Resuscitation 2016; 103: 49-53
  • 32 Baik-Schneditz N, Schwaberger B, Bresesti I. et al. Fetal to neonatal transition: what additional information can be provided by cerebral near infrared spectroscopy?. (published correction appears in Pediatr Res 2022 Jun 23) Pediatr Res 2022; (e-pub ahead of print) DOI: 10.1038/s41390-022-02081-0.
  • 33 Urlesberger B, Kratky E, Rehak T. et al. Regional oxygen saturation of the brain during birth transition of term infants: comparison between elective cesarean and vaginal deliveries. J Pediatr 2011; 159 (03) 404-408
  • 34 Pichler G, Baik N, Urlesberger B. et al. Cord clamping time in spontaneously breathing preterm neonates in the first minutes after birth: impact on cerebral oxygenation - a prospective observational study. J Matern Fetal Neonatal Med 2016; 29 (10) 1570-1572
  • 35 Arifler D, Zhu T, Madaan S, Tachtsidis I. Optimal wavelength combinations for near-infrared spectroscopic monitoring of changes in brain tissue hemoglobin and cytochrome c oxidase concentrations. Biomed Opt Express 2015; 6 (03) 933-947
  • 36 Nasr VG, Bergersen LT, Lin HM. et al. Validation of a second-generation near-infrared spectroscopy monitor in children with congenital heart disease. Anesth Analg 2019; 128 (04) 661-668
  • 37 Siddiqui MF, Lloyd-Fox S, Kaynezhad P, Tachtsidis I, Johnson MH, Elwell CE. Changes in cytochrome-c-oxidase account for changes in attenuation of near-infrared light in the healthy infant brain. Adv Exp Med Biol 2018; 1072: 7-12
  • 38 Magasich-Airola NP, Momeni M, Sanchez Torres C. et al. Regional oxygen saturation measured by two different oximetry monitors in infants and children undergoing living donor liver transplantation with bilirubin measurements: a prospective observational study. Paediatr Anaesth 2023; 33 (03) 201-210
  • 39 Rodriguez MJ, Corredera A, Martinez-Orgado J, Arruza L. Interference between cerebral NIRS and conjugated bilirubin in extremely low birth weight neonates. An Pediatr (Engl Ed) 2021; 95: 371-373