Cerebral Oxygenation, Extraction, and Autoregulation in Very Preterm Infants Who Develop Peri-Intraventricular Hemorrhage

Objective To test the hypothesis that near-infrared spectroscopy (NIRS)-determined patterns of regional cerebral oxygen saturation (rScO 2 ), cerebral fractional tissue oxygen extraction (cFTOE), and autoregulatory ability can identify neonates at risk for developing peri-intraventricular hemorrhage (PIVH). Study design This case-control study is a subanalysis of 30 neonates who developed PIVH >12 hours after admission as part of a lager prospective observational cohort study comprising 650 preterm neonates born at ≤32 weeks' gestational age. PIVH was diagnosed by cranial ultrasound, performed at least once daily. Mean arterial blood pressure (MABP), NIRS-determined rScO 2, cFTOE, and MABP–rScO 2 correlation were monitored from birth to 72 hours of age. Results Infants with PIVH received more inotropic drugs before being diagnosed with PIVH. Significantly more infants with severe PIVH needed treatment for patent ductus arteriosus. The MABP–rScO 2 correlation was >0.5 significantly more often before mild/moderate PIVH and after severe PIVH compared with controls. rScO 2 was higher and cFTOE lower in infants before severe PIVH. Conclusion NIRS-monitored rScO 2 and cFTOE suggest cerebral hyperperfusion in infants with severe PIVH. Moreover, MABP–rScO 2 correlation indicates more blood pressure-passive brain perfusion in infants with PIVH. Continuous assessment of patterns of cerebral oxygenation and arterial blood pressure may identify those preterm infants at risk for severe PIVH and prompt consideration of preventive measures.