Cerebral Oxygenation in Neonates Immediately after Cesarean Section and Mode of Maternal Anesthesia

Abstract

Background: Cerebral regional oxygen saturation (crSO₂) during immediate transition and resuscitation immediately after birth is of increasing interest. Objectives: The aim of the present study was to assess whether the type of maternal anesthesia during cesarean section (CS; general anesthesia vs. spinal anesthesia) has an influence on cerebral oxygenation during immediate neonatal transition after birth. Methods: Secondary outcome parameters of prospective observational studies were analyzed. Neonates born by CS from November 2009 to September 2016 at the Medical University of Graz (Austria) were eligible. Term and preterm neonates were included, provided that: (1) crSO₂ was measured by near-infrared spectroscopy, and (2) peripheral arterial oxygen saturation (SpO₂) and heart rate (HR) were measured by pulse oximetry during the first 15 min after birth. Administration of supplemental oxygen was recorded and cerebral fractional tissue oxygen extraction (cFTOE) was calculated out of crSO₂ and SpO₂. For comparison, term and preterm neonates with maternal general anesthesia were matched to neonates with maternal spinal anesthesia during CS. Results: Out of 760 eligible neonates, 64 term (38.8 ± 0.9 weeks of gestation; 32 neonates in each group) and 54 preterm neonates (32.0 ± 2.9 weeks of gestation; 27 neonates in each group) were included. In term neonates, maternal general anesthesia was associated with lower initial SpO₂, HR values, and Apgar scores. The fraction of inspired oxygen (FiO₂) was statistically significantly higher in the general anesthesia group. Nevertheless, crSO₂ and cFTOE did not differ statistically significantly between the groups. In preterm neonates there were no statistically significant differences in SpO₂, HR, crSO₂, and cFTOE between the general and spinal anesthesia groups. Apgar scores at 1 min were statistically significantly lower and FiO₂ was statistically significantly higher in the general anesthesia group. Conclusion: Cerebral tissue oxygenation in neonates during immediate transition after birth was similar after maternal general and spinal anesthesia during CS, despite differences in SpO₂, HR, and supplemental oxygen in term neonates and differences in supplemental oxygen in preterm neonates.