Cerebral oxygen saturation during the first 72h after birth in infants diagnosed prenatally with congenital heart disease

Abstract

Background: Evidence suggests that hypoxic-ischemic brain injury in infants with congenital heart disease already occurs during early life. The aim of our study was, therefore, to assess the course of regional cerebral oxygen saturation (r_cSO₂) and fractional tissue oxygen extraction (FTOE) during the first 72h after birth in infants with prenatally diagnosed duct-dependent congenital heart disease. In addition, we identified clinical parameters that were associated with r_cSO₂.

Materials and methods: We included 56 infants with duct-dependent congenital heart disease. We measured arterial oxygen saturation (SpO₂) and r_cSO₂ during the first 72h after birth. Simultaneously, we calculated FTOE.

Results: We observed median r_cSO₂ values of approximately 60%, a decreasing FTOE from 0.34 on day 1 to 0.28 on day 3 and stable preductal SpO₂ values around 90%. Several clinical variables were associated with r_cSO₂. In a multiple linear regression model only type of CHD and preductal SpO₂ were significant predictors of r_cSO₂ during the first three days after birth. Infants with a duct-dependent pulmonary circulation had up to 12% lower r_cSO₂ values than infants with a duct-dependent systemic circulation.

Conclusion: We demonstrated that, during the first three days after birth, cerebral oxygen saturation is low in infants with duct-dependent congenital heart disease. Furthermore, this study provides preoperative reference values of r_cSO₂ and FTOE in infants with duct-dependent CHD.

Keywords: Congenital heart disease; Near-infrared spectroscopy; Neonatal intensive care unit; Newborn infants; Pulmonary circulation; Systemic circulation.