The hidden consequence of intraventricular hemorrhage: persistent cerebral desaturation after IVH in preterm infants

Abstract

Background: Previous studies describe a short-term decrease in cerebral oxygen saturation (StO2) after intraventricular hemorrhage (IVH) in premature infants; little is known about long-term implications. Methods: Infants born <30 weeks gestational age (GA) were included. Clinical characteristics, hemoglobin measurements, highest grade of IVH, and white matter injury (WMI) were noted. NIRS monitoring occurred daily or every other day for four weeks; weekly through 36 weeks GA. Recordings were error-corrected before calculation of mean StO2 and fractional tissue oxygen extraction (FTOE). Mean StO2 and FTOE were plotted by postnatal age and injury group (IVH/no IVH; WMI/no WMI). Non-linear regression by locally-estimated scatterplot smoothing was used to generate the best-fit line and CI. Results: 1237 recordings from 185 infants were included; mean length=6.5h; mean GA=26.3w; mean BW=951g; overall/severe IVH incidence was 29/8%, WMI incidence was 16%. IVH was independently associated with an acute drop in StO2 which remained lower for 68d. Severe IVH was associated with lower StO2 values than mild IVH. WMI was associated with early and persistent elevation of FTOE. Conclusion: IVH of any grade is associated with a prolonged cerebral desaturation, WMI is associated with prolonged elevation of FTOE. This finding is exacerbated for infants with severe IVH.

Early Vital Sign Differences in Very Low Birth Weight Infants with Severe Intraventricular Hemorrhage

“…In a recent report, Vesoulis et al showed that IVH is associated with prolonged cerebral desaturation, as well as fractional tissue oxygen extraction. 32 Other investigator found similar alterations in cerebral oxygenation in neonates with IVH, 33 suggesting that impaired cerebral autoregulation is an important mechanism of IVH in these patients. Further studies, combining frequent imaging, as well as prospective VS analytics and cerebral oxygenation monitoring, may help address the mechanisms underlying the observed changes in VS patterns in neonates with sIVH.…”

Deep cerebral venous abnormalities in premature babies with GMH-IVH: a single-centre retrospective study

“…Finally, a decrease in cerebral saturations have also been noted after severe GMH-IVH possibly due to disturbance in intracranial blood flow. 37 …”

Neuroprotection of the Perinatal Brain by Early Information of Cerebral Oxygenation and Perfusion Patterns

“…It may be clear that prevention or early recognition and down tuning of cerebral hyper(hypo-)perfusion/-oxygenation and/or a fluctuating pattern of the cerebral blood flow potentially reduce or even prevent the occurrence and extension of PIVHs. In this respect it is especially important to aim for a stable arterial carbon dioxide level within normal limits (i.e., [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50]. Monitoring the pattern of cerebral oxygenation using NIRSdetermined rScO 2 as early after birth as possible, preferably already on the resuscitation table, at least up to postnatal day 4 in these vulnerable group of neonates can alert the clinician at an early point in time for hypercapnia-induced hyperoxygenation/hyperperfusion [25,35] and hypoxia-or hypocapnia-induced underoxygenation/hypoperfusion [32] of the immature brain.…”

“…A follow-up study at 15 and 24 months corrected age of a cohort of 734 preterm infants showed an association between low rScO 2 values and adverse neurodevelopmental outcome at 2 years of age [39]. A recent prospective study in 185 extremely preterm neonates using NIRS-monitored rScO 2 showed that prolonged cerebral desaturation was associated with the occurrence of any grade of PIVH [40]. So, early intervention to quickly normalize the arterial carbon dioxide, cerebral oxygen saturation levels, and prevention of large fluctuations in cerebral perfusion due to lack of autoregulatory ability of the cerebral vascular bed ("hands off" policy and/or sedation) will probably lower the PIVH incidence and its severity [41].…”