Transcutaneous Microcirculatory Imaging in Preterm Neonates

The overall goal of this procedure is to visualize the peripheral perfusion of preterm infants on a micro circulatory level. This method can help us answer key questions about hemodynamics in critical ill preterm infants. The main advantage of this technique is that it's non-invasive and therefore causes limited burden to the Newborn patient.

The implications of this technique extends towards the early detection of neonatal sepsis. As in previous research in adults, microcirculation is shown to be altered in septic states. Visual demonstration of this technique is critical because the video steps are difficult to learn and there is a great need of standardization in the research field.

Schedule the micro circulatory measurement so that it does not coincide with other procedures such as blood sampling. Perform this measurement after feeding to prevent infant agitation. Ensure that a nurse or parent comforts the neonate during the examination by using the principles of newborn individualized development Care and assessment program.

In order to obtain the best quality of images, have two individuals perform the procedure. One who holds the camera and is focused on the neonate and the other who operates the computer and software. If the clinical condition of the neonate permits place the neonate in a supine position as performing micro circulatory imaging in a pro position would require more skill and patience.

Finally, ensure that the body temperature of the preterm infant is within the appropriate range. Begin by installing the device along the incubator. Ensure that the incubator is at the right height such that it is in line with the camera operator's arm.

Put a clear disposable cap on the camera and then apply oil to the tip of the probe to help smoothen the contact between probe and skin. Next, place the camera on the ventromedial side of the infant's upper arm to prevent focus artifacts. Make sure the probe is perpendicular to the skin.

The ventromedial side of the upper arm is the primary location to measure the cutaneous microcirculation. This location has little lenu hair and is therefore less prone to artifacts. To minimize the total length of the procedure, find the optimal depth of focus while searching for the location with the fewest artifacts, stabilize the probe to avoid movement artifacts by having the camera operator rest their elbow on the incubator window and wrist beside the neonate.

Avoid pressure artifacts by only letting the camera have the slightest contact with the skin. Next record videos for a minimum duration of five seconds. After a successful capture, move the camera to another spot on the upper arm.

In total, capture five to 10 videos at three to five different locations as some videos may not be usable for analysis. Finally, gently remove the gel from the skin with a small piece of gauze. First crop the video if there is a significant movement that impedes analysis.

Go to the tool section and click on editor. Select the frame interval eligible for analysis, and click the crop video button. Next, select the cropped video and stabilize it.

Go to the tool section and click on analysis. Then click stabilize. This is the last step before the automatic analysis.

Now select the stabilized video. Go to the analysis section and click detect. Highlight the options for capillaries and vessels.

Finally, after detection, click the CNA or the deb backer button for a full micro circulatory report, which includes the most used outcome parameters, such as total vessel density, perfused vessel density, and the proportion of perfused vessels. As an alternative, export the videos offline to manually analyze on another computer by going to the tool section and selecting export and a VA export. This protocol demonstrates the optimal approach for obtaining high quality micro circulatory images in critically ill or preterm neonates.

Here, transcutaneous images of an infant born at 24 weeks are shown at day one and day 28 after birth. Adequate focus depth is very important when acquiring micro circulatory images. As inadequate focus results in a loss of vessel visibility.

Furthermore, once standardized offline analysis is complete, other outcome parameters such as vessel density can be calculated Once mastered, this technique can be performed in several minutes. While attempting this procedure, it's important to remember to avoid pressure artifacts and hair artifacts. Also, the videos must be of a minimum length of three seconds after its this technique paved the way for researchers in the field of microcirculation to explore the human dynamics of small vessels in newborn infants.

After watching this video, you should have a good understanding how to perform proper measurements and obtain high quality images of the skin microcirculation in newborn infants.