Cerebral Oxygenation in Preterm Infants Developing Cerebral Lesions
Angelika L. Schwab, Benjamin Mayer, Dirk Bassler, Helmut Hummler, Hans Fuchs, Manuel B. Bryant
Abstract
Background We investigated the association between cerebral tissue oxygen saturation (cStO 2 ) 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 cStO 2 monitoring, initiated at the earliest time possible and recorded until 72 h of life. Mean cStO 2 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 cStO 2 of healthy study participants and calculated the area under the threshold (AUT). cStO 2 <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 cStO 2 was significantly lower in infants with IVH/PVL as well as severe IVH/PVL. In addition, we observed critical events defined by mean cStO 2 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 cStO 2 is lower in infants developing IVH/PVL. This may be related to lower oxygenation and/or perfusion and implies that cStO 2 could potentially serve as an indicator of imminent cerebral lesions.