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Multicenter Study
. 2022 Oct;92(4):1034-1041.
doi: 10.1038/s41390-022-02082-z. Epub 2022 May 5.

Early brain and abdominal oxygenation in extremely low birth weight infants

Valerie Y Chock  1 , Emily Smith  2 , Sylvia Tan  2 , M Bethany Ball  3 , Abhik Das  4 , Susan R Hintz  3 , Haresh Kirpalani  5 , Edward F Bell  6 , Lina F Chalak  7 , Waldemar A Carlo  8 , C Michael Cotten  9 , John A Widness  6 , Kathleen A Kennedy  10 , Robin K Ohls  11   12 , Ruth B Seabrook  13 , Ravi M Patel  14 , Abbot R Laptook  15 , Toni Mancini  5 , Gregory M Sokol  16 , Michele C Walsh  17 , Bradley A Yoder  12 , Brenda B Poindexter  14 , Sanjay Chawla  18 , Carl T D'Angio  19 , Rosemary D Higgins  20   21 , Krisa P Van Meurs  3 ; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Affiliations
Multicenter Study

Early brain and abdominal oxygenation in extremely low birth weight infants

Valerie Y Chock et al. Pediatr Res. 2022 Oct.

Abstract

Background: Extremely low birth weight (ELBW) infants are at risk for end-organ hypoxia and ischemia. Regional tissue oxygenation of the brain and gut as monitored with near-infrared spectroscopy (NIRS) may change with postnatal age, but normal ranges are not well defined.

Methods: A prospective study of ELBW preterm infants utilized NIRS monitoring to assess changes in cerebral and mesenteric saturation (Csat and Msat) over the first week after birth. This secondary study of a multicenter trial comparing hemoglobin transfusion thresholds assessed cerebral and mesenteric fractional tissue oxygen extraction (cFTOE and mFTOE) and relationships with perinatal variables.

Results: In 124 infants, both Csat and Msat declined over the first week, with a corresponding increase in oxygen extraction. With lower gestational age, lower birth weight, and 5-min Apgar score ≤5, there was a greater increase in oxygen extraction in the brain compared to the gut. Infants managed with a lower hemoglobin transfusion threshold receiving ≥2 transfusions in the first week had the lowest Csat and highest cFTOE (p < 0.001).

Conclusion: Brain oxygen extraction preferentially increased in more immature and anemic preterm infants. NIRS monitoring may enhance understanding of cerebral and mesenteric oxygenation patterns and inform future protective strategies in the preterm ELBW population.

Impact: Simultaneous monitoring of cerebral and mesenteric tissue saturation demonstrates the balance of oxygenation between preterm brain and gut and may inform protective strategies. Over the first week, oxygen saturation of the brain and gut declines as oxygen extraction increases. A low hemoglobin transfusion threshold is associated with lower cerebral saturation and higher cerebral oxygen extraction compared to a high hemoglobin transfusion threshold, although this did not translate into clinically relevant differences in the TOP trial primary outcome. Greater oxygen extraction by the brain compared to the gut occurs with lower gestational age, lower birth weight, and 5-min Apgar score ≤5.

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Figures

Figure 1:
Figure 1:
NIRS measures over the first week with 95% confidence intervals demonstrate a decrease in cerebral saturation (Csat) and mesenteric saturation (Msat) and an increase in cerebral fractional tissue oxygen extraction (cFTOE) and mesenteric fractional tissue oxygen extraction (mFTOE). Systemic saturation (SpO2) and splanchnic cerebral oxygenation ratio did not exhibit a significant change in pattern.
Figure 2:
Figure 2:
NIRS measures of cerebral and mesenteric saturation (Csat and Msat) and cerebral and mesenteric oxygen extraction (cFTOE and mFTOE) differ based on gestational age, small for gestational age (SGA) status, and 5-minute Apgar score. Predicted NIRS measures are shown using cubic regression lines with 95% confidence intervals in the first week.
Figure 3:
Figure 3:
Mean cerebral saturation (Csat) varies with transfusion parameters and time in the first week of age. Those with the lowest mean Csat had 2 or more transfusions and were in the low hemoglobin transfusion threshold arm. Mean Csat and 95% confidence intervals are shown for each group at selected time points of 48, 96, and 144 hours after birth.
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