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PEDIATRICS Vol. 111 No. 1 January 2003, pp. e73-e76

ELECTRONIC ARTICLE

Slow Blood Sampling From an Umbilical Artery Catheter Prevents a Decrease in Cerebral Oxygenation in the Preterm Newborn

Gabriele Schulz, MD, Esther Keller, Daniel Haensse, MSc, Romaine Arlettaz, MD, Hans Ulrich Bucher, MD and Jean-Claude Fauchère, MD

From the Clinic of Neonatology, University Hospital, Zurich, Switzerland

--> Objective. Blood sampling from an umbilical artery catheter (UAC) placed in a high position (thoracal 6–9) has the potential to produce clinically significant changes in cerebral blood flow and, thereby, in cerebral oxygenation. This may contribute to cerebral impairment in preterm newborn infants. Therefore, we set up a study to determine the effects of different sampling speeds through a UAC on cerebral oxygenation in preterm infants.

Methods. Thirty pairs of measurements were conducted on 20 preterm infants (median gestational age: 30.14 weeks; median birth weight: 1170 g). For each infant, 2 blood samplings (both 2.3 mL, including flush volume) through the UAC in high position were taken at 2 different speeds (20 and 40 seconds) in alternating sequence. Cerebral oxygenation was measured noninvasively by near-infrared spectroscopy. Concentration changes in cerebral oxygenated hemoglobin (O2Hb) and deoxygenated hemoglobin (HHb), along with the tissue oxygenation index (TOI; O2Hb/[O2Hb + HHb] x 100), were recorded while blood was withdrawn and subsequently reinfused.

Results. A significant decrease in O2Hb and TOI occurred during blood sampling within 20 seconds (median {Delta}O2Hb: -1.5 µmol/L; range: -4.1–2.3; median {Delta}TOI: -0.6%; range: -6.3–2.3), whereas HHb increased (median {Delta}HHb: 0.4 µmol/L, range: -1.1–3.9). No significant change was found in O2Hb, HHb, and TOI when sampling time was extended to 40 seconds.

Conclusion. Our results show that blood withdrawal over 20 seconds from a UAC in high position significantly decreases cerebral O2Hb and TOI in preterm infants. Prolonging sampling time to 40 seconds can prevent this phenomenon.

Key Words: near-infrared spectroscopy • cerebral tissue oxygenation • neonate • tissue oxygenation index

Abbreviations: UAC, umbilical artery catheter • NIRS, near-infrared spectroscopy • TOI, tissue oxygenation index • O2Hb, oxygenated hemoglobin concentration • HHb, deoxygenated hemoglobin concentration

Received for publication Jan 29, 2002; Accepted Sep 10, 2002.