Aim: Cardiac function is a major factor for tissue perfusion and therefore may affect the tissue oxygen saturation. Aim was to analyse possible associations between cardiac function parameters and cerebral and peripheral tissue oxygenation in neonates on the first day after birth.Methods: For the present study, we analysed secondary outcome parameters of a previously performed prospective single centre observational study. The prospective study was conducted at the Medical University of Graz, Austria between September 2011 and June 2013. We included preterm and term neonates who were admitted to the neonatal intensive care unit and in whom simultaneous near‐infrared spectroscopy measurements and echocardiography were obtained on the first day after birth. Cardiac function parameters were correlated to cerebral and peripheral tissue oxygen saturation and cerebral and peripheral fractional tissue oxygen extraction at the time of echocardiography.Results: A total of 60 neonates of whom 47 were preterm and 13 were term (median gestational age: 34; IQR 33‐35 weeks, mean birth weight: 2276 ± 774 grams) were included. There were no statistically significant correlations between cardiac function parameters and regional tissue oxygenation parameters.Conclusion: In the present study, we found no correlation between regional tissue oxygenation and parameters of cardiac function in cardio‐circulatory stable neonates on the first day after birth.

Body temperature (BT) management remains a challenge in neonatal intensive care, especially during resuscitation after birth. Our aim is to analyze whether there is an association between the BT and cerebral and peripheral tissue oxygen saturation (crSO₂/cTOI and prSO₂), arterial oxygen saturation (SpO₂), and heart rate (HR). The secondary outcome parameters of five prospective observational studies are analyzed. We include preterm and term neonates born by Caesarean section who received continuous pulse oximetry and near-infrared spectroscopy monitoring during the first 15 min, and a rectal BT measurement once in minute 15 after birth. Four-hundred seventeen term and 169 preterm neonates are included. The BT did not correlate with crSO₂/cTOI and SpO₂. The BT correlated with the HR in all neonates (ρ = 0.210, p < 0.001) and with prSO₂ only in preterm neonates (ρ = −0.285, p = 0.020). The BT was lower in preterm compared to term infants (36.7 [36.4–37.0] vs. 36.8 [36.6–37.0], p = 0.001) and prevalence of hypothermia was higher in preterm neonates (29.5% vs. 12.0%, p < 0.001). To conclude, the BT did not correlate with SpO₂ and crSO₂/cTOI, however, there was a weak positive correlation between the BT and the HR in the whole cohort and a weak correlation between the BT and prSO₂ only in preterm infants. Preterm neonates had a statistically lower BT and suffered significantly more often from hypothermia during postnatal transition.

Background: Peripheral-muscle-fractional-oxygen-extraction (pFOE) and peripheral-muscle-fractional-tissue-oxygen-extraction (pFTOE) are often equated, since both parameters are measured with near-infrared-spectroscopy (NIRS) and estimate oxygen extraction in the tissue. The aim was to investigate the comparability of both parameters and their potential regarding detection of impaired microcirculation. Methods: Term and preterm neonates with NIRS measurements of upper (UE) and lower extremities (LE) were included. pFOE was calculated out of peripheral-muscle-mixed-venous-saturation (pSvO₂), measured with NIRS and venous occlusion, and arterial oxygen saturation (SpO₂). pFTOE was calculated out of peripheral-muscle-tissue-oxygen-saturation and SpO₂. Both parameters were compared using Wilcoxon-Signed-Rank-test and Bland–Altman plots. Results: 341 NIRS measurements were included. pFOE was significantly higher than pFTOE in both locations. Bland–Altman plots revealed limited comparability, especially with increasing oxygen extraction with higher values of pFOE compared to pFTOE. Conclusion: The higher pFOE compared to pFTOE suggests a higher potential of pFOE to detect impaired microcirculation, especially when oxygen extraction is elevated.

Background: Caudal anesthesia is an important regional anesthetic technique in neonates. The placement of a catheter can provide excellent analgesia for a prolonged period; the role of adjuvants, in particular morphine, however, remains unclear. We aimed to describe our experience with caudal catheters for major surgery in neonates. Methods: We included all neonates who had a caudal catheter placed for major abdominal and thoracic surgery and explored postoperative pain management and catheter complications. This retrospective case series included neonates with caudal catheter placement from October 2012 to April 2018 at a tertiary university hospital. Results: A total of 33 caudal catheter placements in 32 neonates were included in this study, of which 28 (85%) were a laparotomy and 5 (15%) a thoracotomy. The mean catheter duration was 135 h with a postoperative failure rate of 3%. Patients who did not receive intravenous opioids postoperatively had a significantly shorter stay in the intensive care unit than those who did (341 h vs. 674 h, p = 0.01). All patients received continuous local anesthetics over the catheter, and 79% received additional intermittent epidural morphine postoperatively for a median period of 42 h. No infectious complications were reported. Conclusions: Caudal catheters are a valuable option for perioperative analgesia for major surgery in neonates. We found no serious catheter-related complication. Further research is needed to define the optimal approach and combination of different analgesic techniques.