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Early oxygen levels contribute to brain injury in extremely preterm infants
Krista Rantakari1, Olli-Pekka Rinta-Koski2, Marjo Metsäranta3
1Children's Hospital, Pediatric Research Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland. krista.rantakari@hus.fi.
Insights
Extremely low gestational age newborns (ELGANs) with abnormal early oxygen levels face higher risks of neurodevelopmental impairments. Strict oxygen saturation targets in the NICU are crucial for improving outcomes in preterm infants.
Area of Science:
- Neonatal care
- Neurodevelopmental disorders
- Pediatric neurology
Background:
- Extremely low gestational age newborns (ELGANs) are susceptible to neurodevelopmental impairments originating in neonatal intensive care unit (NICU) care.
- Early oxygen management, including saturation (SpO2), arterial pO2, and fraction of inspired oxygen (FiO2), may influence later neuroanatomic changes.
Purpose of the Study:
- To investigate the association between early oxygenation parameters and subsequent neurodevelopmental outcomes in ELGANs.
- To determine if specific oxygen levels correlate with white matter injury or altered cortical processing.
Main Methods:
- Retrospective analysis of SpO2, arterial blood gases, and FiO2 in 73 ELGANs during the first 3 postnatal days.
- Correlation of oxygenation data with neuroimaging (white matter injury via MRI), magnetoencephalography (MEG-SII), neurological examination, and developmental quotients (GMDS).
Main Results:
- Lower SpO2, pO2, and higher FiO2 were linked to white matter abnormalities and adverse neurodevelopment.
- Higher SpO2 and pO2, with lower FiO2, correlated with abnormal secondary cortical somatosensory processing (MEG-SII).
- Both severe white matter injury and abnormal MEG-SII were associated with poorer neurodevelopmental outcomes.
Conclusions:
- Early NICU oxygen management significantly impacts neurodevelopmental outcomes in ELGANs.
- Hypoxia appears detrimental to white matter, while hyperoxia may affect cortical processing.
- Strict oxygen saturation targets are essential for optimizing neurodevelopment in preterm infants.
Background:
Extremely low gestational age newborns (ELGANs) are at risk of neurodevelopmental impairments that may originate in early NICU care. We hypothesized that early oxygen saturations (SpO2), arterial pO2 levels, and supplemental oxygen (FiO2) would associate with later neuroanatomic changes.
Methods:
SpO2, arterial blood gases, and FiO2 from 73 ELGANs (GA 26.4 ± 1.2; BW 867 ± 179 g) during the first 3 postnatal days were correlated with later white matter injury (WM, MRI, n = 69), secondary cortical somatosensory processing in magnetoencephalography (MEG-SII, n = 39), Hempel neurological examination (n = 66), and developmental quotients of Griffiths Mental Developmental Scales (GMDS, n = 58).
Results:
The ELGANs with later WM abnormalities exhibited lower SpO2 and pO2 levels, and higher FiO2 need during the first 3 days than those with normal WM. They also had higher pCO2 values. The infants with abnormal MEG-SII showed opposite findings, i.e., displayed higher SpO2 and pO2 levels and lower FiO2 need, than those with better outcomes. Severe WM changes and abnormal MEG-SII were correlated with adverse neurodevelopment.
Conclusions:
Low oxygen levels and high FiO2 need during the NICU care associate with WM abnormalities, whereas higher oxygen levels correlate with abnormal MEG-SII. The results may indicate certain brain structures being more vulnerable to hypoxia and others to hyperoxia, thus emphasizing the role of strict saturation targets.
Impact:
This study indicates that both abnormally low and high oxygen levels during early NICU care are harmful for later neurodevelopmental outcomes in preterm neonates. Specific brain structures seem to be vulnerable to low and others to high oxygen levels. The findings may have clinical implications as oxygen is one of the most common therapies given in NICUs. The results emphasize the role of strict saturation targets during the early postnatal period in preterm infants.
