Cerebral oxygenation is associated with neurodevelopmental outcome of preterm children at age 2 to 3 years

Abstract

Aim: The aim of the study was to determine whether regional cerebral tissue oxygen saturation (rcSO2) and fractional tissue oxygen extraction (FTOE), using near-infrared spectroscopy, are associated with neurodevelopmental outcome of preterm infants. Method: We measured rcSO2 on days 1, 2, 3, 4, 5, 8, and 15 after birth in 83 preterm infants (<32wks gestational age), and calculated FTOE=(SpO2-rcSO2)/SpO2. Cognitive, motor, neurological, and behavioural outcomes were determined at 2 to 3 years using the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III), an age-specific neurological examination, and the Child Behavior Checklist (CBCL) respectively. Multiple linear regression analyses were used to determine whether rcSO2 and FTOE contributed to outcome. Results: We followed up 67 infants. The lower quartile (P25-50) and highest quartile (P75-100) of rcSO2 on day 1 were associated with poorer cognitive outcome (p=0.044 and p=0.008 respectively). A lower area under the curve (AUC; over 15d) of rcSO2 was associated with poorer cognitive outcome (p=0.014). The lower quartile (P25-50) AUC of rcSO2 was associated with poorer fine motor outcome (p=0.004). The amount of time rcSO2 <50% on day 1 was negatively associated with gross motor outcome (p=0.002). The highest quartile of FTOE on day 1 was associated with poorer total motor outcome (p=0.041). Interpretation: Cerebral oxygen saturation during the first 2 weeks after birth is associated with neurodevelopmental outcome of preterm infants at 2 to 3 years. High and low rcSO2 on day 1 were associated with poorer neurodevelopmental outcome. What this paper adds: Neurodevelopmental outcome of preterm children at 2 to 3 years is associated with neonatal cerebral oxygen saturation and extraction. Both high and low cerebral oxygenation are associated with poorer cognitive outcome. High cerebral oxygen extraction is associated with poorer motor outcome.