Background We describe a critical observation during a novel use of near-infrared spectroscopy (NIRS) for aortic coarctation repair in children. Although NIRS has been used in adults to assess tissue oxygen saturation changes in the perispinal microvasculature during repair of thoracoabdominal aneurysms, its use has not been described in infants. The purpose of this study was to characterize tissue oxygen saturation at the T10 level in neonates and children undergoing repair of aortic coarctation.
Methods Ten neonates (< 30 days old) and 4 children (ages 4 to 11 years) with aortic coarctation were enrolled in the study. Cerebral and perispinal regional oxygen saturations (C-rSO2 and S-rSO2) were measured by NIRS sensors (SomaSensors, Somanetics Corp., Troy, MI) placed on the left forehead and lower thoracic dorsal midline at the level of T10. All measurements were made at 1-minute intervals. Ten baseline measurements were made on each patient prior to incision. These were averaged and all subsequent values are reported as percent change from baseline. Results: Neonates demonstrated significant percent drop in S-rSO2 from baseline during each minute following application of cross-clamp while there was no significant change in saturation in older children. Neonates demonstrated return to baseline saturation after cross-clamp removal in all cases. Conclusions: Spinal oximetry in the smallest children is interpretable. Neonates with severe aortic coarctation exhibit a significant drop in lower body tissue saturation during cross clamp, a drop that is not seen in older children. These findings suggest that collateral blood supply after the neonatal period in children with severe coarctation, that clamp times are more critical in the neonate, and may explain postoperative issues with visceral ischemia and reperfusion.
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