Abstract
BackgroundExtremely low gestational age newborns (ELGANs) are at risk of neurodevelopmental impairments that may originate in early NICU care. We hypothesized that early oxygen saturations (SpO2), arterial pO2 levels, and supplemental oxygen (FiO2) would associate with later neuroanatomic changes.MethodsSpO2, arterial blood gases, and FiO2 from 73 ELGANs (GA 26.4 ± 1.2; BW 867 ± 179 g) during the first 3 postnatal days were correlated with later white matter injury (WM, MRI, n = 69), secondary cortical somatosensory processing in magnetoencephalography (MEG-SII, n = 39), Hempel neurological examination (n = 66), and developmental quotients of Griffiths Mental Developmental Scales (GMDS, n = 58).ResultsThe ELGANs with later WM abnormalities exhibited lower SpO2 and pO2 levels, and higher FiO2 need during the first 3 days than those with normal WM. They also had higher pCO2 values. The infants with abnormal MEG-SII showed opposite findings, i.e., displayed higher SpO2 and pO2 levels and lower FiO2 need, than those with better outcomes. Severe WM changes and abnormal MEG-SII were correlated with adverse neurodevelopment.ConclusionsLow oxygen levels and high FiO2 need during the NICU care associate with WM abnormalities, whereas higher oxygen levels correlate with abnormal MEG-SII. The results may indicate certain brain structures being more vulnerable to hypoxia and others to hyperoxia, thus emphasizing the role of strict saturation targets.ImpactThis study indicates that both abnormally low and high oxygen levels during early NICU care are harmful for later neurodevelopmental outcomes in preterm neonates.Specific brain structures seem to be vulnerable to low and others to high oxygen levels.The findings may have clinical implications as oxygen is one of the most common therapies given in NICUs.The results emphasize the role of strict saturation targets during the early postnatal period in preterm infants.
Highlights
● Specific brain structures seem to be vulnerable to low and others to high oxygen levels. ● The findings may have clinical implications as oxygen is one of the most common therapies given in neonatal intensive care units (NICUs). ● The results emphasize the role of strict saturation targets during the early postnatal period in preterm infants
Patient characteristics The study design is shown in Fig. 1 and the clinical characteristics of the Extremely low gestational age newborns (ELGANs) in Table 1A, B
We demonstrate that the ELGANs with later white matter (WM) abnormalities exhibit lower achieved SpO2 during their first 3 days of life than the infants with normal WM
Summary
Low gestational age newborns (ELGANs), born before 28 weeks of gestational age (GA), are at risk of brain injury and later neurodevelopmental complications.[1,2,3,4,5,6,7,8] Many of these complications are thought to originate during their early care, when they are exposed to various factors, such as oxygen, which is one of the most common therapies given in neonatal intensive care units (NICUs).[1,2,7,9,10,11,12,13,14] Inappropriately low oxygen levels are, e.g., associated with increased mortality and impaired neurodevelopment,[9,15,16] and higher levels with retinopathy and lung injury.[16]. The main outcomes were white matter (WM) injury in brain MRI and changes in secondary cortical somatosensory processing measured by MEG-SII, as these abnormalities may originate during the neonatal phase.[8,17,18,19,20,21,22,23] Neurodevelopmental outcome was assessed by Hempel neurological examination and the Griffiths Mental Developmental Scales (GMDS). METHODS: SpO2, arterial blood gases, and FiO2 from 73 ELGANs (GA 26.4 ± 1.2; BW 867 ± 179 g) during the first 3 postnatal days were correlated with later white matter injury (WM, MRI, n = 69), secondary cortical somatosensory processing in magnetoencephalography (MEG-SII, n = 39), Hempel neurological examination (n = 66), and developmental quotients of Griffiths Mental Developmental Scales (GMDS, n = 58). The results may indicate certain brain structures being more vulnerable to hypoxia and others to hyperoxia, emphasizing the role of strict saturation targets
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