Variability of Cerebral Hemoglobin Concentration in Very Preterm Infants During the First 6 Hours of Life

  • Kurt von Siebenthal
  • Matthias Keel
  • Jean-Claude Fauchère
  • Vera Dietz
  • Daniel Haensse
  • Ursula Wolf
  • Urs Helfenstein
  • Oskar Bänziger
  • Hans U. Bucher
  • Martin Wolf
Conference paper
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 566)


Cerebral hemoglobin concentration (cHbc), a major determinant of oxygen transport capacity in the brain, shows a considerable variability due to physiological and methodological factors. In order to determine the (relative) contribution of these factors, the cHbc variability within the first 6 hours of life was studied in 28 very preterm infants using near infrared spectrophotometry (NIRS). Mean cHbc values were 46.4 ± 14.1 µmol/1 (2.75 ± 0.84 ml/100 g). Is the variability in cHbc related to the methodology of cHbc measurements or to physiological variables? A statistical model of stepwise regression (backward selection) with 13 independent variables and with cHbc as a dependent variable showed that, from the total variability of ± 14.1 µmol/1, only 3.7 µmol/1 (26%) were of methodological origin, while the major portion, 9.3 µmol/1 (66%) were related to four physiological variables: birth weight, gestational age, blood glucose and transcutaneous carbon dioxide tension. The remaining 1.1 µmol/1 (7.8%) were unexplained.

We conclude that NIRS, which allows continuous monitoring of cerebral oxygenation and metabolism even in the first hours of postnatal life, is a valid technique to measure cHbc in very preterm infants. The major portion of the large variability of early cHbc registrations can be attributed to physiological factors.


Birth Weight Preterm Infant Physiological Variable Cerebral Blood Volume Cerebral Oxygenation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    B. Hagberg, G. Hagberg, I. Olow, and L. van Wendt, The changing panorama of cerebral palsy in Sweden, VII. Prevalence and origin in the birth year period 1987–90, Acta Paediatrica 85, 954–960 (1996).PubMedCrossRefGoogle Scholar
  2. 2.
    R. Largo, D. Pfister, L. Molinari, S. Kundu, A. Lipp, and G. Duc, Significance of prenatal, perinatal and postnatal factors in the development of AGA preterm infants at five and seven years, Dev. Med. Child Neurol. 31, 440–456 (1989).PubMedCrossRefGoogle Scholar
  3. 3.
    M. Graham, M. Levene, J. Trounce, and N. Rutter, Prediction of cerebral palsy in very low birth weight infants: prognostic ultrasound study, Lancet 2(8559), 593–596 (1987).PubMedCrossRefGoogle Scholar
  4. 4.
    D. Wertheim, E. Mercuri, J. Faundez, M. Rutherford, D. Acolet, and L. Dubowitz, Prognostic value of continuous electroencephalographic recording in full term infants with hypoxic ischaemic encephalopathy, Arch. Dis. Child 71, F97–F102 (1994).PubMedGoogle Scholar
  5. 5.
    L. Hellström-Westas, I. Rosen, and N. Svenningsen, Predictive value of early continuous amplitude integrated EEG recordings on outcome after severe birth asphyxia in full term infants, Arch. Dis. Child 72, F32–F38 (1995).Google Scholar
  6. 6.
    M. Wolf, H. U. Bucher, V. Dietz, M. Keel, K. von Siebenthal, and G. Duc, How to evaluate slow oxygenation changes to estimate absolute cerebral haemoglobin concentration by Near Infrared Spectrophotometry, Adv. Exp. Med. Biol. 411, 495–501 (1996).Google Scholar
  7. 7.
    J. E. Brazy, Near-infrared spectroscopy, Clin. Perinatol. 18, 519–534 (1991).PubMedGoogle Scholar
  8. 8.
    K. von Siebenthal, G. Bernert, and P. Casaer, Near-infrared spectroscopy in newborn infants, Brain Dev. 14, 135–143 (1992).Google Scholar
  9. 9.
    H. U. Bucher, A. D. Edwards, A. E. Lipp, and G. Duc, Comparison between near infrared spectroscopy and 133Xenon clearance for estimation of cerebral blood flow in critically ill preterm infants, Pediatr. Res. 33, 56–60 (1993).PubMedGoogle Scholar
  10. 10.
    C. E. Elwell, A Practical Users Guide to Near Infrared Spectroscopy, (Hamamatsu Photonics, Japan, 1995).Google Scholar
  11. 11.
    J. S. Wyatt, M. Cope, D. T. Delpy, C. E. Richardson, A. D. Edwards, S. Wray, and E. O. Reynolds, Quantitation of cerebral blood volume in human infants by near-infrared spectroscopy, J. Appl. Physiol. 68, 1086–1091 (1990).PubMedGoogle Scholar
  12. 12.
    S. Matcher, C. Elwell, C. Cooper, M. Cope, and D. Delpy, Performance comparison of several published tissue near-infrared spectroscopy algorithms, Anal. Biochem. 227, 54–68 (1995).PubMedCrossRefGoogle Scholar
  13. 13.
    J. S. Wyatt, M. Cope, D. T. Delpy, P. van der Zee, S. Arridge, A. D. Edwards, and E. O. Reynolds, Measurement of optical path length for cerebral near-infrared spectroscopy in newborn infants, Dev. Neurosci. 12, 140–144 (1990).PubMedGoogle Scholar
  14. 14.
    L. Papile, J. Burstein, and H. Koffler, Incidence and evolution of subependymal and intraventricular haemorrhage: A study of infants with birth weights less than 1500 g, J. Pediatr. 92, 529–534 (1978).PubMedCrossRefGoogle Scholar
  15. 15.
    A. J. Miller, Subset Selection in Regression (2nd edition), (Chapman & Hall/CRC Press, London & New York, 2002).Google Scholar
  16. 16.
    N. C. Brun, and G. Greisen, Cerebrovascular responses to carbon dioxide as detected by near-infrared spectrophotometry: comparison of three different measures, Pediatr. Res. 36, 20–24 (1994).PubMedGoogle Scholar
  17. 17.
    R. Grubb, M. Raichle, C. Higgins, and J. Eichling, Measurement of regional blood volume by emission tomography, Ann. Neurol. 4, 322–328 (1978).PubMedCrossRefGoogle Scholar
  18. 18.
    F. Sakai, K. Nakazawa, Y. Tazaki, K. Ishii, H. Hino, H. Igarashi, and T. Kanda, Regional cerebral blood flow and blood volume and hematocrit measured in normal human volunteers by single-photon emission computed tomography, J. Cereb. Blood Flow. Metab. 5, 207–213 (1985).PubMedGoogle Scholar
  19. 19.
    V. Ramaekers, P. Casaer, H. Daniels, and G. Marchal, Upper limits of brain flow autoregulation in stable infants of various conceptional age, Early Human. Dev. 24, 249–258 (1990).CrossRefGoogle Scholar
  20. 20.
    J. S. Wyatt, D. A. Edwards, M. Cope, D. T. Delpy, D. C. McCormick, A. Potter, and E. O. Reynolds, Response of cerebral blood volume to changes in arterial carbon dioxide tension in preterm and term infants, Pediatr. Res. 29, 553–557 (1991).PubMedGoogle Scholar
  21. 21.
    V. Dietz, M. Wolf, M. Keel, K. von Siebenthal, O. Baenziger, and H. U. Bucher, CO2 reactivity of cerebral haemoglobin concentration in healthy newborns measured by near infrared spectrophotometry, Biol. Neonate 75, 85–90 (1999).PubMedCrossRefGoogle Scholar
  22. 22.
    O. Pryds, G. Greisen, and B. Friis-Hansen, Compensatory increase of CBF in preterm infants during hypoglycaemia, Acta Paediatr. Scand. 77, 632–637 (1988).PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • Kurt von Siebenthal
  • Matthias Keel
  • Jean-Claude Fauchère
  • Vera Dietz
  • Daniel Haensse
  • Ursula Wolf
  • Urs Helfenstein
  • Oskar Bänziger
  • Hans U. Bucher
  • Martin Wolf

There are no affiliations available

Personalised recommendations