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. 2022 Apr 12:10:809248.
doi: 10.3389/fped.2022.809248. eCollection 2022.

Cerebral Oxygenation in Preterm Infants Developing Cerebral Lesions

Angelika L Schwab  1 , Benjamin Mayer  2 , Dirk Bassler  3 , Helmut D Hummler  1 , Hans W Fuchs  1 , Manuel B Bryant  1   3
Affiliations

Cerebral Oxygenation in Preterm Infants Developing Cerebral Lesions

Angelika L Schwab et al. Front Pediatr. .

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://clinicaltrials.gov/ct2/show/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.

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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.

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).
See this image and copyright information in PMC

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