Cerebral Oxygenation in Preterm Infants Developing Cerebral Lesions

Angelika L Schwab, Benjamin Mayer, Dirk Bassler, Helmut D Hummler, Hans W Fuchs, Manuel B Bryant, Angelika L Schwab, Benjamin Mayer, Dirk Bassler, Helmut D Hummler, Hans W Fuchs, Manuel B Bryant

Abstract

Background: We investigated the association between cerebral tissue oxygen saturation (cStO2) measured by near-infrared spectroscopy (NIRS) and cerebral lesions including intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL).

Methods: Preterm infants <1,500 g received continuous cStO2 monitoring, initiated at the earliest time possible and recorded until 72 h of life. Mean cStO2 over periods of 5, 15, 30 min and 1 h were calculated. To calculate the burden of cerebral hypoxia, we defined a moving threshold based on the 10th percentile of cStO2 of healthy study participants and calculated the area under the threshold (AUT). cStO2 <60% for >5 min was regarded a critical event. The study was registered on clinicaltrials.gov (ID NCT01430728, URL: https://ichgcp.net/clinical-trials-registry/NCT01430728?id=NCT01430728&draw=2&rank=1).

Results: Of 162 infants (gestational age: mean 27.2 weeks, standard deviation 20 days; birth weight: mean 852 g, standard deviation 312 g) recorded, 24/12 (14.8%/7.4) developed any/severe IVH/PVL. Mean cStO2 was significantly lower in infants with IVH/PVL as well as severe IVH/PVL. In addition, we observed critical events defined by mean cStO2 over 5 min <60% in four infants with severe IVH/PVL during NIRS monitoring. AUT showed no statistically significant difference between outcome groups.

Conclusion: These findings suggest that cStO2 is lower in infants developing IVH/PVL. This may be related to lower oxygenation and/or perfusion and implies that cStO2 could potentially serve as an indicator of imminent cerebral lesions.

Keywords: cStO2; cerebral ischemia; cerebral oxygenation; intraventricular hemorrhage (IVH); near-infrared spectroscopy (NIRS); periventricular leukomalacia (PVL); preterm infant.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Schwab, Mayer, Bassler, Hummler, Fuchs and Bryant.

Figures

Figure 1
Figure 1
Patient flow diagram of preterm infants recorded study at the neonatal intensive care unit at Ulm University Children's Hospital during the study period between October 2010 and May 2014.
Figure 2
Figure 2
Total count of preterm infants recorded over time and percentage of calculated mean cStO2. The study population is represented on the left y-axis, outcome groups are represented on the right y-axis.
Figure 3
Figure 3
Comparison of cStO2 (median and interquartile range over 1 h) between outcome groups on the first day of life (A), on the second day of life (B), and on the third day of life (C).
Figure 4
Figure 4
Thresholds of the healthy control group (n = 105) throughout the first 2 h (A) and in the first 3 days of life (B).
Figure 5
Figure 5
Critical event with cStO2 <60% in a preterm infant with severe IVH after intubation. In addition, preterm infants without IVH/PVL are presented (median and interquartile range).
Figure 6
Figure 6
Comparison of CFTOE (median and interquartile range over 1 h) between outcome groups on the first day of life (A), on the second day of life (B), and on the third day of life (C).

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