Abstract
Objective: To investigate if preterm neonates with arterial oxygen saturation (SpO2)<80% at 5 min after birth show different regional cerebral tissue oxygen saturation (rcStO2), compared to infants reaching the target.Methods: Retrospective analysis of four prospective observational studies. Preterm neonates needing respiratory support during delivery room stabilization were included. Regional cerebral tissue oxygen saturation was measured with near-infrared spectroscopy (NIRS) during the first 15 min after birth along with SpO2 and heart rate (HR). Neonates were divided into two groups: those with a 5-min SpO2 ≥ 80% (“≥80% group”) and those with a 5-min SpO2 < 80% (“<80% group”). Groups were compared regarding rcStO2, SpO2, and HR. Furthermore, we analyzed whether a 5-min SpO2 < 80% was associated with a rcStO2 below the 10th percentile at the same time point.Results: 146 neonates were included, with 68 (47%) in the “≥80% group” and 78 (53%) in the “<80% group.” Neonates in the “ <80% group” had a significantly lower rcStO2 (p < 0.001). Furthermore, 80.3% of neonates in the “ <80% group” and 23.4% in the “≥80% group” had rcStO2 values below the 10th percentile at 5 min (p < 0.001). HR was significantly lower at minute 3 and 4 in the “ <80% group” (p < 0.002).Conclusion: Preterm infants needing respiratory support, who do not reach the SpO2 target of 80% at 5 min after birth, show significantly diminished rcStO2 values compared to neonates reaching the target.
Highlights
Within the last years a significant amount of research has been undertaken trying to understand the physiological processes during neonatal transition
There seems to be a narrow range for Arterial oxygen saturation (SpO2) targeting, as preterm infants are at risk of organ injury due to biochemical oxidative stress on the one hand, and at risk for hypoxic injury due to respiratory insufficiency on the other hand [7,8,9,10,11]
A study by Oei et al showed that preterm infants initially resuscitated with room air (21% oxygen) had an increased risk of hospital death compared to infants resuscitated with 100% oxygen
Summary
Within the last years a significant amount of research has been undertaken trying to understand the physiological processes during neonatal transition. A study by Oei et al showed that preterm infants initially resuscitated with room air (21% oxygen) had an increased risk of hospital death compared to infants resuscitated with 100% oxygen They showed that in preterm neonates, not reaching a 5-min SpO2 of 80%, risk of mortality increased [12, 13]. The same authors performed a meta-analysis of eight randomized controlled oxygen titration trials and demonstrated that almost half of the preterm infants did not reach a 5-min SpO2 of 80%. This was associated with a higher risk of developing bradycardia and intraventricular hemorrhage (IVH) [13]. Monitoring SpO2 and heart rate (HR) by pulse oximetry may not provide adequate information about the oxygen supply to the brain, as oxygen delivery depends on SpO2 and organ perfusion [14]
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