Low Cerebral Oxygenation in Preterm Infants Is Associated with Adverse Neurodevelopmental Outcome

Abstract

Objective: To assess whether high and low levels of cerebral oxygenation (regional cerebral oxygenation [rScO 2 ]) 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 rScO 2 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 rScO 2 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 rScO 2 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 rScO 2 . The composite motor outcome was not significantly related to either low or high values or rScO 2 . Conclusions: Low, but not high, rScO 2 was associated with an unfavorable cognitive outcome. This suggests the use of a threshold of rScO 2 <55% for future clinical studies when using adult near-infrared sensors (rScO 2 <65% for neonatal sensors, approximately).