Association between early cerebral oxygenation and neurodevelopmental impairment or death in premature infants

Katheria, Anup; Stout, J. Benjamin; Morales, Alexandra; Poeltler, Debra; Rich, Wade; Steen, Jane; Nuzzo, Shauna; Finer, Neil N.

doi:10.1038/s41372-021-00942-w

Cited by 10 publications

(9 citation statements)

References 15 publications

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“…In extremely preterm infants, low cerebral oxygenation saturation during the first 96 h after birth is associated with increased risk of mortality and brain injury, including intraventricular hemorrhage and periventricular leukomalacia ( 46 , 47 ). Observational studies in very preterm infants have also reported that a higher burden of cerebral hypoxia during the first 72 h, and lower area under the curve for cerebral oxygenation saturation during the first two weeks of life was associated with neurodevelopmental impairment ( 48 , 49 ). These findings suggest that cerebral oxygenation monitoring might improve outcomes in the early neurocritical care of preterm infants.…”

Section: Introductionmentioning

confidence: 99%

Cerebral Oxygenation and Metabolism After Hypoxia-Ischemia

et al. 2022

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Perinatal hypoxia-ischemia (HI) is still a significant contributor to mortality and adverse neurodevelopmental outcomes in term and preterm infants. HI brain injury evolves over hours to days, and involves complex interactions between the endogenous protective and pathological processes. Understanding the timing of evolution of injury is vital to guide treatment. Post-HI recovery is associated with a typical neurophysiological profile, with stereotypic changes in cerebral perfusion and oxygenation. After the initial recovery, there is a delayed, prolonged reduction in cerebral perfusion related to metabolic suppression, followed by secondary deterioration with hyperperfusion and increased cerebral oxygenation, associated with altered neurovascular coupling and impaired cerebral autoregulation. These changes in cerebral perfusion are associated with the stages of evolution of injury and injury severity. Further, iatrogenic factors can also affect cerebral oxygenation during the early period of deranged metabolism, and improving clinical management may improve neuroprotection. We will review recent evidence that changes in cerebral oxygenation and metabolism after HI may be useful biomarkers of prognosis.

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Section: Introductionmentioning

confidence: 99%

Cerebral Oxygenation and Metabolism After Hypoxia-Ischemia

et al. 2022

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“…Studies have so far investigated how measures of SO 2 and OEF obtained in the first days of life are associated with later neurodevelopmental outcomes in infants born very preterm with inconsistent results. Two cohort studies of infants born before 32 weeks GA indicated that a lower cerebral SO 2 in the first 72 h of life was associated with lower cognitive scores at 24 months CA (Alderliesten et al, 2019;Katheria et al, 2021). In a study of 67 infants born before 32 weeks GA, lower SO 2 in the first 2 weeks of life was associated with less optimal neurodevelopment at 2-3 years of age, while higher OEF on the first day of life was associated with lower motor scores (Verhagen et al, 2015).…”

Section: Discussionmentioning

confidence: 94%

Associations between neurological examination at term-equivalent age and cerebral hemodynamics and oxygen metabolism in infants born preterm

Côté-Corriveau

Simard²,

Beaulieu³

et al. 2023

Front. Neurosci.

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BackgroundInfants born at 29–36 weeks gestational age (GA) are at risk of experiencing neurodevelopmental challenges. We hypothesize that cerebral hemodynamics and oxygen metabolism measured by bedside optical brain monitoring are potential biomarkers of brain development and are associated with neurological examination at term-equivalent age (TEA).MethodsPreterm infants (N = 133) born 29–36 weeks GA and admitted in the neonatal intensive care unit were enrolled in this prospective cohort study. Combined frequency-domain near infrared spectroscopy (FDNIRS) and diffuse correlation spectroscopy (DCS) were used from birth to TEA to measure cerebral hemoglobin oxygen saturation and an index of microvascular cerebral blood flow (CBFi) along with peripheral arterial oxygen saturation (SpO2). In combination with hemoglobin concentration in the blood, these parameters were used to derive cerebral oxygen extraction fraction (OEF) and an index of cerebral oxygen metabolism (CMRO2i). The Amiel-Tison and Gosselin Neurological Assessment was performed at TEA. Linear regression models were used to assess the associations between changes in FDNIRS-DCS parameters from birth to TEA and GA at birth. Logistic regression models were used to assess the associations between changes in FDNIRS-DCS parameters from birth to TEA and neurological examination at TEA.ResultsSteeper increases in CBFi (p < 0.0001) and CMRO2i (p = 0.0003) were associated with higher GA at birth. Changes in OEF, CBFi, and CMRO2i from birth to TEA were not associated with neurological examination at TEA.ConclusionIn this population, cerebral FDNIRS-DCS parameters were not associated with neurological examination at TEA. Larger increases in CBFi and CMRO2i from birth to TEA were associated with higher GA. Non-invasive bedside FDNIRS-DCS monitoring provides cerebral hemodynamic and metabolic parameters that may complement neurological examination to assess brain development in preterm infants.

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“…17 A recent study by Katheria et al showed an increase in neurodevelopmental impairment in infants less than 32 weeks of gestation when the rScO 2 was less than 67%. 19 Each of these studies looked at premature infants during the first 72 hours of life.…”

Section: Discussionmentioning

confidence: 99%

Decreased Cerebral Oxygenation in Premature Infants with Progressive Posthemorrhagic Ventricular Dilatation May Help with Timing of Intervention

et al. 2023

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Objective The objective of this study was to determine the degree of progressive posthemorrhagic ventricular dilatation (PHVD) that is associated with a significant decrease in regional cerebral oxygen saturation (rScO2) in premature infants at risk for periventricular–intraventricular hemorrhage (PIVH). Study Design Cranial ultrasound (US) and near-infrared spectroscopy (NIRS) measurements of rScO2 were performed on inborn infants with birth weights less than 1,250 g on admission and at 1, 4, and 8 weeks of age. Infants with severe PIVH were studied weekly. A 1-hour average of rScO2 was compared with the frontal–occipital horn ratio (FOHR) measured the same day. Generalized linear models were used to analyze the relationship between FOHR and rScO2, by severity of PIVH, and adjusted for gestational age. Cut-off points of 0.55 for FOHR and 45% for rScO2 were used to calculate odds ratios (OR) and 95% confidence intervals (CI). Results The study cohort included 63 infants with normal US, 15 with grade-1 or -2 PIVH (mild group), and 21 with grade-3 or -4 PIVH (severe group). Increases in FOHR in the severe group were associated with decreases in rScO2 at 1 week (p = 0.036), 4 weeks (p = 0.013), and 8 weeks of life (p = 0.001) compared with the normal and mild groups. Infants with FOHR greater than 0.55 were 92% more likely to have rScO2 less than 45% when compared with infants with FOHR less than 0.55 (OR = 0.08, 95% CI: [0.04, 0.13], p < 0.001). Conclusion Progressive PHVD (FOHR > 0.55) is a strong predictor of compromised cerebral oxygenation. A combination of rScO2 and FOHR measurements may aid in identifying infants with PHVD that would benefit from early intervention. Key Points

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Association between early cerebral oxygenation and neurodevelopmental impairment or death in premature infants

Cited by 10 publications

References 15 publications

Cerebral Oxygenation and Metabolism After Hypoxia-Ischemia

Cerebral Oxygenation and Metabolism After Hypoxia-Ischemia

Associations between neurological examination at term-equivalent age and cerebral hemodynamics and oxygen metabolism in infants born preterm

Decreased Cerebral Oxygenation in Premature Infants with Progressive Posthemorrhagic Ventricular Dilatation May Help with Timing of Intervention

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