Cerebral Oxygen Saturation to Guide Oxygen Delivery in Preterm Neonates for the Immediate Transition after Birth: A 2-Center Randomized Controlled Pilot Feasibility Trial

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. © The Authors. Published by SPIE under a Creative Commons Attribution 3.0 Unported License. Distribution or reproduction of this work in whole or in part requires full attribution of the original publication, including its DOI.

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“…Also in this trial the burden of cerebral hypoxia-as defined by a minute-to-minute reference curve-was reduced in the NIRSvisible group. 13 …”

Section: Current Statusmentioning

confidence: 99%

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

et al. 2016

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“…Near-infrared spectrospcopy (NIRS) may be a useful adjunct, and there have been a number of recent DR-orientated studies addressing the use of NIRS [40,41]. It is easy to apply and there is very little delay in signal acquisition.…”

Section: How To Determine Which Infants Require Vrmentioning

confidence: 99%

Optimising Intravenous Volume Resuscitation of the Newborn in the Delivery Room: Practical Considerations and Gaps in Knowledge

Finn¹,

Roehr²,

Ryan³

et al. 2017

Neonatology

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Volume resuscitation (VR) for the treatment of newborn shock is a rare but potentially lifesaving intervention. Conducting clinical studies to assess the effectiveness of VR in the delivery room during newborn stabilization is challenging. We review the available literature and current management guidelines to determine which infants will benefit from VR, the frequency of VR, and the choice of agents used. In addition, the potential role for placental transfusion in the prevention of newborn shock is explored.

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“…However, excessive O 2 tensions occur in the brain when care providers increase the FiO 2 more than is necessary to compensate for pulmonary deficits during certain time periods. Before discussing therapeutic approaches, we aim to emphasise the need for the real-time monitoring of brain oxygen levels in routine NICU settings to prevent hyperoxia [129][130][131] . Technical advances in this field should receive higher priority than solely focussing on the discovery of therapies treating hyperoxia-induced injury.…”

Section: Therapeutic Approachesmentioning

confidence: 99%

Hyperoxia and the Immature Brain

et al. 2016

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Despite major advances in obstetrics and neonatal intensive care, preterm infants frequently suffer from neurological impairments in later life. Preterm and also full-term neonates are generally susceptible to injury caused by reactive oxygen species due to the immaturity of endogenous radical scavenging systems. It is well known that high oxygen levels experienced during the critical phase of maturation can profoundly influence developmental processes. Supraphysiological oxygen concentrations used for resuscitation or in the care of critically ill infants are known to have deleterious effects on the developing lung and retina, contributing to the pathophysiology of neonatal diseases like bronchopulmonary dysplasia and retinopathy of prematurity. Moreover, experimental work from the last decade suggests that hyperoxia also leads to neuronal and glial cell death, contributing to the injury of white and grey matter observed in preterm infants. During the critical phase of brain maturation, hyperoxia can alter developmental processes, resulting in the disruption of neural plasticity and myelination. However, oxygen therapy can often not be avoided in neonatal intensive care. Therefore, in situations requiring oxygen supplementation, in addition to the development of appropriate monitoring systems, protective and/or regenerative strategies are highly warranted. Here, we summarise the clinical and experimental evidence as well as potential therapeutic strategies, providing an overview of the pathophysiology of oxygen exposure on the developing central nervous system and its impact on neonatal brain injury.

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Cerebral Oxygen Saturation to Guide Oxygen Delivery in Preterm Neonates for the Immediate Transition after Birth: A 2-Center Randomized Controlled Pilot Feasibility Trial

Cited by 86 publications

References 29 publications

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

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

Optimising Intravenous Volume Resuscitation of the Newborn in the Delivery Room: Practical Considerations and Gaps in Knowledge

Hyperoxia and the Immature Brain

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