Cerebral oximetry in preterm infants: an agenda for research with a clear clinical goal

Abstract

Preterm birth constitutes a major cause of death before 5 years of age and it is a major cause of neurodevelopmental impairment across the world. Preterm infants are most unstable during the transition between fetal and newborn life during the first days of life and most brain damage occurs in this period. The brain of the preterm infant is accessible for tissue oximetry by near-infrared spectroscopy. Cerebral oximetry has the potential to improve the long-term outcome by helping to tailor the support of respiration and circulation to the individual infant's needs, but the evidence is still lacking. The goals for research include testing the benefit and harms of cerebral oximetry in large-scale randomized trials, improved definition of the hypoxic threshold, better understanding the effects of intensive care on cerebral oxygenation, as well as improved precision of oximeters and calibration among devices or standardization of values in the hypoxic range. These goals can be pursued in parallel.

Keywords: brain hypoxia; brain injuries; clinical study; near-infrared spectroscopy; preterm infant.

Fig. 1

The ultimate goal is to support preterm infants in an individualized manner during the physiological transition from fetal life. Due to their size and fragility all measures must be carefully adapted to their needs. Cerebral oximetry by NIRS has the potential to detect harmful cerebral hypoxia for timely intervention.

Fig. 2

The burden of cerebral hypoxia in 166 extremely preterm infants included in the SafeBoosC-II randomized clinical trial. The burden was reduced to less than half in the experimental group. The control group had blinded recording of cerebral oxygenation while the experimental group had the actual cerebral oxygen displayed and could act on cerebral hypoxia with the help of a clinical guideline.