Orthogonal Polarization Spectral Imaging (OPS) Measurements of Microcirculatory Changes in Term Newborns with Suspected Infection
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vor 13 Jahren
The early diagnosis of neonatal infection remains a challenge.
Recent studies using Optical Polarized Spectral (OPS) imaging
techniques, have reported microcirculatory alterations in adult
patients with severe sepsis and septic shock. The objective of this
study was to compare microcirculatory flow and vascular density
between healthy controls and sick newborns with neonatal infection.
OPS images were obtained prospectively from the vascular bed of ear
conch and upper arm of 47 newborns on their 1st, 2nd and 3rd day of
life. Infection was defined as IL-6 >50pg /mL and CRP >0,5 mg
/dL. OPS sequences were analyzed off-line, blinded to clinical
status of the infant with a semi-quantitative method based on the
works of Sakr (46) and Boerma (47). Flow was examined
differentiating between no flow, intermittent, sluggish and
continuous flow. All vessels that did not have a continuous flow
were classified as pathologic and their percentage was determined.
Vascular density of the sequences was also calculated. Sixteen
infants developed an infection. Most episodes of infection were not
severe. Microcirculatory data was analyzed and tested with a non
parametric test. The images obtained from ear showed a better image
quality and an easier performan¬ce than those from upper arm in
term newborns (infection: 32%, 95% confidence interval [19-44] vs.
healthy: 10% [6-13]; p= 0.0003). Despite a tendency to higher
percent of impaired flow, the microcirculatory flow in arm did not
reach a statistical significance when comparing both groups
(infection: 19% [16-25] vs. healthy: 13% [10-11]; p= non
significant). A trend to lower vascular density was observed in the
sequences obtained from ear in the infected group but not in those
obtained from arm. Both places did not show a statistical
difference. It can be concluded that ear conch is a better site to
study the microcirculation in term newborns than the arm. In the
ear conch even in infants with mild to moderate signs of infection,
microcirculatory flow is impaired in a large proportion of vessels
early in the course of disease. Since these changes can be easily
recognized at the external ear, an on-line evaluation of
microcirculatory flow could be an important screening tool for
infection in the future.
Recent studies using Optical Polarized Spectral (OPS) imaging
techniques, have reported microcirculatory alterations in adult
patients with severe sepsis and septic shock. The objective of this
study was to compare microcirculatory flow and vascular density
between healthy controls and sick newborns with neonatal infection.
OPS images were obtained prospectively from the vascular bed of ear
conch and upper arm of 47 newborns on their 1st, 2nd and 3rd day of
life. Infection was defined as IL-6 >50pg /mL and CRP >0,5 mg
/dL. OPS sequences were analyzed off-line, blinded to clinical
status of the infant with a semi-quantitative method based on the
works of Sakr (46) and Boerma (47). Flow was examined
differentiating between no flow, intermittent, sluggish and
continuous flow. All vessels that did not have a continuous flow
were classified as pathologic and their percentage was determined.
Vascular density of the sequences was also calculated. Sixteen
infants developed an infection. Most episodes of infection were not
severe. Microcirculatory data was analyzed and tested with a non
parametric test. The images obtained from ear showed a better image
quality and an easier performan¬ce than those from upper arm in
term newborns (infection: 32%, 95% confidence interval [19-44] vs.
healthy: 10% [6-13]; p= 0.0003). Despite a tendency to higher
percent of impaired flow, the microcirculatory flow in arm did not
reach a statistical significance when comparing both groups
(infection: 19% [16-25] vs. healthy: 13% [10-11]; p= non
significant). A trend to lower vascular density was observed in the
sequences obtained from ear in the infected group but not in those
obtained from arm. Both places did not show a statistical
difference. It can be concluded that ear conch is a better site to
study the microcirculation in term newborns than the arm. In the
ear conch even in infants with mild to moderate signs of infection,
microcirculatory flow is impaired in a large proportion of vessels
early in the course of disease. Since these changes can be easily
recognized at the external ear, an on-line evaluation of
microcirculatory flow could be an important screening tool for
infection in the future.
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