Cerebral oxygenation measurements during immediate neonatal transition in the delivery room: a systematic review

To systematically review the use of NIRS measured cerebral oxygenation and analyse these parameters during the immediate postnatal period.

EMBASE, MEDLINE, and Maternity and Infant Care databases using keywords: "Infants," "NIRS," and "Cerebral oxygenation."

Inclusion criteria were clinical trials and observational studies measuring cerebral oxygenation up to 15 min of life. Exclusion criteria were non-human studies, non-English articles and case reports.

Two authors independently performed study selection, data extraction, and risk of bias assessment. Cerebral regional tissue Oxygenation (CrSO₂) and cerebral fractional tissue oxygenation extraction (cFTOE) values were extracted.

Fifty nine studies, out of 4067 were included in the qualitative analysis. Studies included aimed to establish oxygenation reference ranges, assess the impact of delivery mode, cord clamping, and delivery room interventions on cerebral oxygenation, and evaluated its role in predicting long-term neurodevelopmental outcomes. Most studies focused on term neonates experiencing normal neonatal transitions. Aggregate mean values for CrSO₂ and cFTOE in the first 15 min of life were calculated, showing that a steady state is achieved by 10-15 min of life. ANOVA demonstrated no significant differences between preterm and term infants in CrSO₂ (p = 0.54) and cFTOE (p = 0.50).

NIRS measurement of CrSO₂ is feasible and can be used alongside other clinical tools to inform delivery room management. There were no significant differences in CrSO₂ or cFTOE between term and preterm infants although most studies focussed on late preterm infants. Future research is therefore required for extremely preterm infants, those requiring ventilatory management, or those with congenital anomalies.

There is a knowledge gap regarding cerebral oxygenation patterns during immediate neonatal transition. NIRS can be used to monitor and guide clinical management in delivery room, helping to inform clinicians about cerebral oxygenation during the transition. This study provides a comprehensive review of NIRS applications in measuring neonatal CrSO₂ up to 15 min after birth, producing a collated reference range graph with no significant differences found between gestations. This study enhances the understanding and application of NIRS during the immediate transitional period, providing insights that can improve delivery room management practices and guide interventions for both term and preterm infants.