Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.
Research Unit for Neonatal Micro- and Macrocirculation, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.
BMC Pediatr. 2023 Mar 30;23(1):145. doi: 10.1186/s12887-023-03960-z.
Prematurity is associated with increased risk for morbidity and mortality. Aim of this study was to evaluate whether cerebral oxygenation during fetal-to-neonatal transition period was associated with long-term outcome in very preterm neonates.
Preterm neonates ≤ 32 weeks of gestation and/or ≤ 1500 g with measurements of cerebral regional oxygen saturation (crSO) and cerebral fractional tissue oxygen extraction (cFTOE) within the first 15 min after birth were analysed retrospectively. Arterial oxygen saturation (SpO) and heart rate (HR) were measured with pulse oximetry. Long-term outcome was assessed at two years using "Bayley Scales of Infant Development" (BSID-II/III). Included preterm neonates were stratified into two groups: adverse outcome group (BSID-III ≤ 70 or testing not possible due to severe cognitive impairment or mortality) or favorable outcome group (BSID-III > 70). As the association between gestational age and long-term outcome is well known, correction for gestational age might disguise the potential association between crSO and neurodevelopmental impairment. Therefore, due to an explorative approach the two groups were compared without correction for gestational age.
Forty-two preterm neonates were included: adverse outcome group n = 13; favorable outcome group n = 29. Median(IQR) gestational age and birth weight were 24.8 weeks (24.2-29.8) and 760 g (670-1054) in adverse outcome group and 30.6 weeks (28.1-32.0) (p = 0.009*) and 1250 g (972-1390) (p = 0.001*) in the favorable outcome group, respectively. crSO was lower (significant in 10 out of 14 min) and cFTOE higher in adverse outcome group. There were no difference in SpO, HR and fraction of inspired oxygen (FiO), except for FiO in minute 11, with higher FiO in the adverse outcome group.
Preterm neonates with adverse outcome had beside lower gestational age also a lower crSO during immediate fetal-to-neonatal transition when compared to preterm neonates with age appropriate outcome. Lower gestational age in the adverse outcome group would suggest beside lower crSO also lower SpO and HR in this group, which were however similar in both groups.
早产与发病率和死亡率增加有关。本研究的目的是评估胎儿到新生儿过渡期的脑氧合是否与极早产儿的长期预后相关。
回顾性分析胎龄≤32 周和/或出生体重≤1500g 的早产儿，在出生后 15 分钟内测量脑局部氧饱和度（crSO）和脑组织氧摄取分数（cFTOE）。通过脉搏血氧饱和度仪测量动脉血氧饱和度（SpO）和心率（HR）。使用“贝利婴幼儿发展量表”（BSID-II/III）在两年时评估长期预后。将纳入的早产儿分为两组：不良结局组（BSID-III≤70 或因严重认知障碍或死亡而无法进行测试）或良好结局组（BSID-III＞70）。由于胎龄与长期预后的关系众所周知，对胎龄进行校正可能会掩盖 crSO 与神经发育障碍之间的潜在关联。因此，由于采用了探索性方法，在未经胎龄校正的情况下对两组进行了比较。
共纳入 42 例早产儿：不良结局组 n=13；良好结局组 n=29。不良结局组的中位（IQR）胎龄和出生体重分别为 24.8 周（24.2-29.8）和 760g（670-1054），良好结局组分别为 30.6 周（28.1-32.0）（p=0.009*）和 1250g（972-1390）（p=0.001*）。不良结局组 crSO 较低（14 分钟中有 10 分钟有显著差异），cFTOE 较高。两组间 SpO、HR 和吸入氧分数（FiO）无差异，仅在第 11 分钟 FiO 较高。
与胎龄适当的早产儿相比，不良结局早产儿在胎儿到新生儿过渡期间 crSO 较低，且胎龄较低。不良结局组 crSO 较低，提示该组 SpO 和 HR 也较低，但两组间 HR 相似。
