Low Cerebral Oxygenation in Preterm Infants Is Associated with Adverse Neurodevelopmental Outcome - 19/12/18

Doi : 10.1016/j.jpeds.2018.11.038

Thomas Alderliesten, MD, PhD ^1,^* , Frank van Bel, MD, PhD ¹, Niek E. van der Aa, MD, PhD ¹, Paul Steendijk, MSc, PhD ², Ingrid C. van Haastert, MA, PhD ¹, Linda S. de Vries, MD, PhD ¹, Floris Groenendaal, MD, PhD ¹, Petra Lemmers, MD, PhD ¹
¹ Department of Neonatology, Wilhelmina Children's Hospital, Utrecht University, Utrecht, The Netherlands
² Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

^*Reprint requests: Thomas Alderliesten, MD, PhD, Wilhelmina Children's Hospital/University Medical Center Utrecht, Department of Neonatology, Room KE04.123.1, PO Box 85090, Utrecht 3584 AE, The Netherlands.Wilhelmina Children's Hospital/University Medical Center UtrechtDepartment of NeonatologyRoom KE04.123.1PO Box 85090Utrecht3584 AEThe Netherlands

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 19 December 2018

Abstract

Objective

To assess whether high and low levels of cerebral oxygenation (regional cerebral oxygenation [rScO₂]) in infants born at <32 weeks of gestation were associated with adverse long-term outcome.

Study design

Observational cohort study including preterm infants born at <32 weeks of gestation at the Wilhelmina Children's Hospital, The Netherlands, between April 2006 and April 2013. The rScO₂ was continuously monitored for 72 hours after birth using near-infrared spectroscopy. Outcome was assessed at 15 and 24 months of corrected age by certified investigators. An unfavorable composite outcome was defined as an outcome score below -1 SD or death. Various rScO₂ thresholds were explored.

Results

In total, 734 infants were eligible for analysis, 60 of whom died. Associations with an unfavorable cognitive outcome in multivariable analysis were comparable for time spent with a rScO₂ below 55% and -1.5 SD (according to published reference values), with an OR of 1.4 (CI 1.1-1.7) for 20% of time below either threshold. Results at 15 months were comparable with results at 24 months. Results were not statistically significant for thresholds defining high values of rScO₂. The composite motor outcome was not significantly related to either low or high values or rScO₂.

Conclusions

Low, but not high, rScO₂ was associated with an unfavorable cognitive outcome. This suggests the use of a threshold of rScO₂ <55% for future clinical studies when using adult near-infrared sensors (rScO₂ <65% for neonatal sensors, approximately).

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Keywords : Near-infrared spectroscopy, neonatology, neurology, hemodynamics

Abbreviations : Bayley-III, GMDS, NIRS, ROC, rScO₂, SES