Abstract
OBJECTIVE: To examine whether variation of regional cerebral oxygen saturation (rScO(2)) within three days after delivery predicts development of brain injury (intraventricular/cerebellar hemorrhage or white matter injury) in preterm infants. STUDY DESIGN: A prospective study of neonates <32 weeks gestational age with normal cranial ultrasound admitted between 2018 and 2022. All received rScO(2) monitoring with near-infrared spectroscopy at admission up to 72 h of life. To assess brain injury a magnetic resonance imaging was performed at term-equivalent age. We assessed the association between rScO(2) variability (short-term average real variability, rScO(2ARV), and standard deviation, rScO(2SD)), mean rScO(2) (rScO(2MEAN)), and percentage of time rScO(2) spent below 60% (rScO(2TIME<60%)) during the first 72 h of life and brain injury. RESULTS: The median [IQR] time from birth to brain imaging was 68 [59-79] days. Of 81 neonates, 49 had some form of brain injury. Compared to neonates without injury, in those with injury rScO(2ARV) was higher during the first 24 h (P = 0.026); rScO(2SD) was higher at 24 and 72 h (P = 0.029 and P = 0.030, respectively), rScO(2MEAN) was lower at 48 h (P = 0.042), and rScO(2TIME<60%) was longer at 24, 48, and 72 h (P = 0.050, P = 0.041, and P = 0.009, respectively). Similar results were observed in multivariable logistic regression. Although not all results were statistically significant, increased rScO(2) variability (rScO(2ARV) and rScO(2SD)) and lower mean values of rScO2 were associated with increased likelihood of brain injury. CONCLUSIONS: In preterm infants increased aberration of rScO(2) in early postdelivery period was associated with an increased likelihood of brain injury diagnosis at term-equivalent age.