Combined multimodal monitoring during neonatal transition in preterm infants: feasibility, safety and...

The transitional period involves major cardiovascular adaptations that could affect cerebral perfusion. Combined multimodal monitoring (CMM) may provide a more comprehensive physiological assessment than individual monitoring modalities. We aimed to evaluate the feasibility and safety of CMM integrating near-infrared spectroscopy (NIRS), amplitude-integrated electroencephalography (aEEG), targeted neonatal echocardiography (TNE), and head ultrasound (HUS) during the transitional period in preterm infants ≤ 32 weeks' gestation and to explore healthcare professionals' perceptions following its implementation. Prospective observational cohort study. Participants underwent continuous NIRS and aEEG monitoring, two TNE assessment and one HUS during the first 72 h of life. Feasibility was defined as acquisition of ≥ 75% of intended NIRS and aEEG recording time, and completion of all imaging studies. Safety outcomes included TNE-related procedural intolerance and NIRS-related skin reactions. Healthcare professionals completed a post-implementation survey assessing acceptability and perceived clinical usefulness. Forty-seven infants were included. Overall CMM feasibility was 78.7%. Individual monitoring completion was 93.6% for NIRS, 95.7% for aEEG, 89.3% for TNE and 100% for HUS. Transient desaturations occurred in 7.9% of 89 TNE assessments, while mild NIRS-related erythema occurred in 11.3% of monitored infants. Healthcare professionals reported favorable perceptions of CMM, particularly regarding clinical relevance and complementarity with standard monitoring.

CMM was feasible and well tolerated during the first 72 h of life in preterm infants ≤ 32 weeks' gestation and was perceived favorably by healthcare professionals. Future studies are needed to explore its impact on clinically relevant outcomes.

• The transitional period in preterm infants involves complex cardiovascular and cerebral adaptations associated with an increased risk of brain injury. • Individual monitoring modalities (NIRS, aEEG, TNE and HUS) provide complementary information on cardiovascular and cerebral physiology but are commonly assessed separately.

• Structured CMM integrating NIRS, aEEG, TNE and HUS is feasible and well tolerated during the transitional period in preterm infants ≤ 32 weeks' gestation. • Healthcare professionals perceive CMM as clinically relevant and complementary to standard monitoring, supporting further evaluation of integrated multimodal assessment in neonatal care.