Cerebral and peripheral regional oxygen saturation during postnatal transition in preterm neonates

Abstract

Objective: To evaluate peripheral regional oxygen saturation (rpSO₂) and cerebral regional oxygen saturation (rcSO₂) during the immediate postnatal transition in late preterm infants with and without the need for respiratory support.

Study design: This was a prospective observational study using near-infrared spectroscopy to evaluate changes in rpSO₂ and rcSO₂. These variables were measured during the first 15 minutes of life after elective cesarean delivery. Peripheral oxygen saturation (SpO₂) and heart rate were measured continuously by pulse oximetry, and cerebral fractional tissue oxygen extraction (cFTOE) was calculated. Two groups were compared based on their need for respiratory support: a respiratory support group and a normal transition group. Positive-pressure ventilation was delivered with a T-piece resuscitator, and oxygen was adjusted based on SpO₂ values. A Florian respiratory function monitor was used to record the ventilation variables.

Results: There were 21 infants in the normal transition group and 21 infants in the respiratory support group. Changes in heart rate over time were similar in the 2 groups. SpO₂, rcSO₂, and rpSO₂ values were consistently higher in the normal transition group. In the respiratory support group, cFTOE values remained significantly elevated for a longer period.

Conclusion: This systematic analysis of rpSO₂, rcSO₂, and cFTOE in late preterm infants found significantly lower oxygen saturation values in infants who received respiratory support compared with a normal transition group. We hypothesize that the elevated cFTOE values in the respiratory support group represent compensation for lower oxygen delivery.

Keywords: CBF; Cerebral blood flow; Cerebral fractional tissue oxygen extraction; Cerebral regional oxygen saturation; FiO(2); Fraction of inspired oxygen; HR; Heart rate; NIRS; Near-infrared spectroscopy; PEEP; Peripheral oxygen saturation; Peripheral regional oxygen saturation; Positive end-expiratory pressure; Regional tissue oxygen saturation; SpO(2); cFTOE; rSO(2); rcSO(2); rpSO(2).