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Published on: August 25, 2022
Cerebral oxygenation in preterm infants with germinal matrix-intraventricular hemorrhages
Elise A Verhagen1, Hendrik J Ter Horst, Paul Keating
1Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. e.a.verhagen@bkk.umcg.nl
Insights
Preterm infants with germinal matrix hemorrhages-intraventricular hemorrhages (GMH-IVH) show persistently reduced cerebral perfusion. Lower regional cerebral oxygen saturation (r(c)SO₂) and higher fractional tissue oxygen extraction (FTOE) were observed during the first two weeks post-birth.
Area of Science:
- Neonatal physiology
- Cerebral hemodynamics
- Neurocritical care
Background:
- Preterm infants are susceptible to germinal matrix hemorrhages-intraventricular hemorrhages (GMH-IVH).
- Cerebral perfusion disturbances are linked to GMH-IVH development.
- Regional cerebral tissue oxygen saturation (r(c)SO₂) and fractional tissue oxygen extraction (FTOE) indicate cerebral perfusion.
Purpose of the Study:
- To investigate the association between r(c)SO₂, FTOE, and GMH-IVH in preterm infants.
- To determine if cerebral perfusion markers differ in preterm infants with and without GMH-IVH.
Main Methods:
- A case-control study involving 17 preterm infants with GMH-IVH (Grades I-III) and 17 matched controls.
- Measurements of r(c)SO₂ and transcutaneous arterial oxygen saturation were taken on Days 1-5, 8, and 15 post-birth.
- FTOE was calculated using the formula: FTOE = (transcutaneous arterial oxygen saturation - r(c)SO₂) / transcutaneous arterial oxygen saturation.
Main Results:
- Infants with GMH-IVH exhibited lower r(c)SO₂ and higher FTOE on Days 1, 2, 3, 4, 5, 8, and 15.
- The most significant differences were observed on Day 5: r(c)SO₂ median 64% (GMH-IVH) vs. 77% (controls), and FTOE median 0.30 vs. 0.17.
- The severity (grade) of GMH-IVH did not influence r(c)SO₂ or FTOE levels.
Conclusions:
- Preterm infants with GMH-IVH demonstrate consistently reduced cerebral perfusion for the first two weeks of life.
- Lower r(c)SO₂ and higher FTOE are indicative of impaired cerebral oxygenation in GMH-IVH cases, regardless of hemorrhage grade.
- These findings suggest persistent cerebral hypoperfusion in preterm infants with GMH-IVH, even with mild hemorrhages.
Background And Purpose:
Preterm infants are at risk of developing germinal matrix hemorrhages-intraventricular hemorrhages (GMH-IVH). Disturbances in cerebral perfusion are associated with GMH-IVH. Regional cerebral tissue oxygen saturation (r(c)SO₂), measured with near-infrared spectroscopy, and fractional tissue oxygen extraction (FTOE) were calculated to obtain an indication of cerebral perfusion. Our objective was to determine whether r(c)SO₂ and FTOE were associated with GMH-IVH in preterm infants.
Methods:
This case-control study included 17 preterm infants with Grade I to III GMH-IVH or periventricular hemorrhagic infarction (median gestational age, 29.4 weeks; range, 25.4 to 31.9 weeks; birth weight, 1260 g; range, 850 to 1840 g). Seventeen preterm infants without GMH-IVH, matched for gestational age and birth weight, served as control subjects (gestational age, 29.9 weeks; range, 26.0 to 31.6 weeks; birth weight, 1310 g; range, 730 to 1975 g). R(c)SO₂ and transcutaneous arterial oxygen saturation were measured during 2 hours on Days 1 to 5, 8, and 15 after birth. FTOE was calculated as FTOE=(transcutaneous arterial oxygen saturation-r(c)SO₂)/transcutaneous arterial oxygen saturation.
Results:
Multilevel analyses showed that r(c)SO₂ was lower and FTOE higher in infants with GMH-IVH on Days 1, 2, 3, 4, 5, 8, and 15. The largest difference occurred on Day 5 with r(c)SO₂ median 64% in infants with GMH-IVH versus 77% in control subjects and FTOE median 0.30 versus 0.17. R(c)SO₂ and FTOE were not affected by the grade of GMH-IVH.
Conclusions:
Preterm infants with GMH-IVH had lower r(c)SO₂ and higher FTOE during the first 2 weeks after birth irrespective of the grade of GMH-IVH. This suggests that cerebral perfusion is decreased persistently for 2 weeks in infants with GMH-IVH, even in the presence of mild hemorrhages.
