About this Research Topic

Background

In neonates, a variety of postnatal disease processes affect organ perfusion and oxygenation during the first weeks of life. During this critical period, preterm infants are highly susceptible to impaired organ blood flow and oxygen delivery, potentially resulting in organ injury. In addition, infants born following intrauterine growth restriction, perinatal hypoxic injury, or with congenital heart disease are similarly at risk for cerebral and/or peripheral organ hypoxic/ischemic injury. Such perturbations during the earliest stages of life are associated with significant risks of neonatal mortality along with an elevated likelihood of neurodevelopmental impairment among survivors.

Conventionally, indirect systemic measures, including heart rate, blood pressure, and pulse oximetry, are monitored to guide clinical management and treatment of sick neonates. In addition, biochemical measurements, including pH, arterial partial pressure of oxygen, and lactate, aid neonatologists in assessment of systemic hemodynamics in these infants. However, these indirect monitoring techniques provide clinically actionable information generated after organ injury has already begun, at which point reactive therapeutic maneuvers may be conducted.

The ability to assess real-time individual tissue oxygenation and oxygen extraction may help clinicians recognize infants at risk for hypoxic organ injury. Indeed, such monitoring may result in earlier management of varied neonatal disease states, including hypoxic-ischemic encephalopathy, clinically significant anemia, and necrotizing enterocolitis, among others. Furthermore, tissue oxygenation monitoring could also provide information concerning regulation of tissue perfusion and/or tissue metabolic demand, thus providing enhanced insight into the pathogenesis of various neonatal disease states.

Over the last two decades, there has been increasing interest in various modalities to assess macro- and micro-perfusion among hemodynamically unstable newborn infants. Near-infrared spectroscopy (NIRS) seems a promising tool to non-invasively assess individual tissue oxygenation, but also has its limitations in clinical practice. In addition, echocardiography and noninvasive assessment of cardiac output also demonstrate promise as methods to improve understanding of organ blood flow among critically ill neonates.

This Research Topic would be looking to:
1) To increase awareness of the need to assess end-organ perfusion and oxygenation
2) To review the benefits and pitfalls of various end-organ monitoring modalities.

Review articles, original research papers on topics related to end-organ monitoring using the above techniques are welcome. The general focus will be on organ perfusion and oxygenation, including cerebral, renal, intestinal, and/or limb oxygenation, with data concerning short and long-term outcomes where available. The use of NIRS, echocardiogram with Doppler, and newer techniques can be described and reported. Preference will be extended to research on the clinical use of combined monitoring strategies.

Keywords: organ perfusion, neonates, tissue oxygenation, near-infrared spectroscopy, echocardiogram

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