Microcirculatory Changes in Term Newborns with Suspected Infection: An Observational Prospective Study

Background. In adults severely disturbed microcirculatory flow can be observed by Orthogonal Polarized Spectral (OPS) imaging techniques during sepsis. Therefore we set out to assess for microcirculatory changes in term newborns with suspected early onset infection using OPS.Methods. OPS images were obtained prospectively from the vascular bed of the ear conch and upper arm of 47 newborns on their 1st, 2nd, and 3rd day of life. OPS sequences were analyzed semiquantitatively offline and blinded to clinical status of the infant. Flow in vessels was classified as continuous or noncontinuous flow and given as proportion of total vessels per image as in the studies in adults.Results. The proportion of vessels with continuous flow was significantly lower in the infants with infection (69% [56–81] versus 90% [87–94](P=0.0003)). None of the infants with infection was in shock or severely septic.Conclusion. In term neonates the microcirculatory flow is impaired in a large proportion of vessels even in mild to moderate infection. These changes can be observed at the onset of disease at the external ear, an optimal site for microcirculatory measurements in term infants.

Orthogonal Polarization Spectral Imaging in Microcirculation

The microcirculation plays a crucial role in the interaction between blood and tissues in physiological pathophysiological pharmacological and clinical states. Despite its significant role in numerous diseases including, hypertension diabetes, sepsis or multiple organ failure, visible and near-infrared light, offer a window into human and animal tissues due to reduced scattering and absorption. We review orthogonal polarization spectral (OPS) imaging method for direct visualization and quantitative assessment of human microcirculation at the bedside are limited. OPS imaging is a relatively new noninvasive method for assessment of human microcirculation without using fluorescent dyes. Recent clinical studies using OPS imaging in various pathological states have shown a wide spectrum of different clinical applications with evident impact on the diagnosis, treatment or prognosis assessment. Thus, there is a great effort to validate OPS imaging for various clinical purposes. The principles of OPS imaging, validation studies, its advantages, limitations, methods of quantitative assessment and current experience in clinical practice are also discussed.

Orthogonal polarization spectral imaging

The microcirculation plays a crucial role in the interaction between blood and tissues both in physiological and pathophysiological states. Despite its critical role in numerous diseases including diabetes, hypertension, sepsis or multiple organ failure, methods for direct visualization and quantitative assessment of human microcirculation at the bedside are limited. Orthogonal polarization spectral (OPS) imaging is a relatively new noninvasive method for assessment of human microcirculation without using fluorescent dyes. Recent clinical studies using OPS imaging in various pathological states have shown a wide spectrum of different clinical applications with evident impact on the diagnosis, treatment or prognosis assessment. Thus, there is a great effort to validate OPS imaging for various clinical purposes. The principles of OPS imaging, validation studies, its advantages, limitations, methods of quantitative assessment and current experience in clinical practice are discussed.