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Effect of Cerebral Oximetry-Guided Treatment on Brain Injury in Preterm Infants as Assessed by Magnetic Resonance
Miguel Alsina-Casanova1,2, Mathias Lühr-Hansen3, Victoria Aldecoa-Bilbao1
1Department of Neonatology, Hospital Clínic Barcelona, BCNatal-Barcelona Center for Maternal Fetal and Neonatal Medicine, Barcelona, Spain.
Insights
Cerebral oximetry monitoring in extremely preterm infants did not significantly alter brain injury detected by MRI. The Kidokoro score showed excellent reliability for assessing brain injury in multicenter trials.
Area of Science:
- Neonatal Neurology
- Neuroimaging
- Critical Care Medicine
Background:
- The SafeBoosC-III trial assessed cerebral oximetry's impact on mortality and brain injury in extremely preterm infants (EPIs).
- This study specifically examined cerebral oximetry's effect on global brain injury using MRI at term equivalent age (TEA).
Purpose of the Study:
- To evaluate the efficacy of cerebral oximetry-guided treatment in reducing global brain injury in EPIs.
- To assess brain injury using magnetic resonance imaging (MRI) at term equivalent age (TEA).
Main Methods:
- MRI scans were performed between 36 and 44.9 weeks postmenstrual age (PMA).
- The Kidokoro score was used to evaluate global brain injury by two blinded assessors.
- Nonparametric Wilcoxon rank sum test and Hodges-Lehmann confidence intervals (CIs) were used to assess intervention effects.
Main Results:
- 121 EPIs underwent MRI at TEA (57 in the cerebral oximetry group, 64 in the usual care group).
- Excellent inter-rater agreement was observed for the Kidokoro score (ICC: 0.93).
- No significant difference in brain injury was found between the cerebral oximetry and usual care groups (p=0.1196).
Conclusions:
- Cerebral oximetry-guided treatment did not significantly alter global brain injury in EPIs as assessed by MRI.
- The Kidokoro score demonstrated high reliability, making it suitable for multicenter trials evaluating brain injury in preterm infants.
Introduction:
The SafeBoosC-III trial investigated the effect of cerebral oximetry-guided treatment in the first 72 h after birth on mortality and severe brain injury diagnosed by cranial ultrasound in extremely preterm infants (EPIs). This ancillary study evaluated the effect of cerebral oximetry on global brain injury as assessed by magnetic resonance imaging (MRI) at term equivalent age (TEA).
Methods:
MRI scans were obtained between 36 and 44.9 weeks PMA. The Kidokoro score was independently evaluated by two blinded assessors. The intervention effect was assessed using the nonparametric Wilcoxon rank sum test for median difference and 95% Hodges-Lehmann (HL) confidence intervals (CIs). The intraclass correlation coefficient (ICC) was used to assess the agreement between the assessors.
Results:
A total of 210 patients from 8 centers were included, of whom 121 underwent MRI at TEA (75.6% of alive patients): 57 in the cerebral oximetry group and 64 in the usual care group. There was an excellent correlation between the assessors for the Kidokoro score (ICC agreement: 0.93, 95% CI: 0.91-0.95). The results showed no significant differences between the cerebral oximetry group (median 2, interquartile range [IQR]: 1-4) and the usual care group (median 3, IQR: 1-4; median difference -1 to 0, 95% HLCI: -1 to 0; p value 0.1196).
Conclusions:
In EPI, the use of cerebral oximetry-guided treatment did not lead to significant alterations in brain injury, as determined by MRI at TEA. The strong correlation between the assessors highlights the potential of the Kidokoro score in multicenter trials.
