Cerebral Oxygenation is Associated with Neurodevelopmental Outcome in Infants Born Preterm with Intraventricular Hemorrhage.

Objective

To examine how cerebral oxygenation levels monitored by near-infrared spectroscopy (NIRS) are associated with neurodevelopmental trajectories in neonates with intraventricular hemorrhage (IVH). STUDY

Design

In this prospective study, 95 neonates born at <34 weeks of gestation with IVH (63 males, median gestational age: 25+6 weeks) between 2013-2023 were included. Regional cerebral oxygen saturation (rScO2) was monitored from IVH diagnosis until term-equivalent age. Analysis included rScO2 levels, duration outside the normal range (<55%; >85%), fluctuations, and cerebral fractional tissue oxygen extraction (cFTOE). Neurodevelopment was assessed at 2-3 years.

Results

Analysis of >20,500 hours of NIRS data revealed that impaired cerebral oxygenation was consistently associated with poorer outcome. Infants with severe cognitive, language, and motor impairment had significantly lower rScO2 (p=0.001), spent more time with rScO2 <55% (p=0.005), and exhibited higher cFTOE (p=0.001) than those with milder or no impairment. Exposure-based analysis demonstrated a clear dose-response relationship: infants in the lowest oxygenation quartiles had significantly worse outcome scores than those in the highest.

Conclusions

Impaired cerebral oxygenation in the early postnatal period is associated with poorer neurodevelopmental outcome in infants with IVH. Parameters such as rScO2, time outside the normal range, and cFTOE were associated with long-term neurodevelopmental outcome. These findings support further investigations of cerebral oxygenation metrics in prospective studies of infants with IVH.