Kenosi, M,O'Toole, JM,Livingston, V,Hawkes, GA,Boylan, GB,O'Halloran, KD,Ryan, AC,Dempsey, EM

2015

November

Journal of Pediatrics

Effects of Fractional Inspired Oxygen on Cerebral Oxygenation in Preterm Infants following Delivery

Validated

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NEAR-INFRARED SPECTROSCOPY BIRTH-WEIGHT INFANTS 100-PERCENT OXYGEN HYPOXIA-ISCHEMIA BRAIN-DAMAGE SATURATION RESUSCITATION ROOM TRANSITION PIGLETS

167

1007

Objectives To explore regional cerebral oxygen saturations (rcSO(2)) in preterm neonates initially stabilized with 0.3 fractionated inspired oxygen (FiO(2)) concentrations. We hypothesized that those infants who received >0.3 FiO(2) during stabilization following delivery would have relatively higher rcSO(2) postdelivery compared with those stabilized with a lower FiO(2).Study design A single center prospective observational study of 47 infants born before 32 weeks. Using near infrared spectroscopy, rcSO(2) values were recorded immediately after birth. All preterm infants were initially given 0.3 FiO(2) and were divided into 2 groups according to subsequent FiO(2) requirements of either <= 0.3 or >0.3 FiO(2). Using a mixed-effects model, we compared the difference between the groups over time. Also, the area measures below 55% (hypoxia) and above 85% (hyperoxia) were compared between the groups.Results The mean (SD) gestation was 29.4 (1.6) weeks and the mean (SD) weight was 1.3 (0.4) kg. Less than onehalf of the infants (20/45; 43%) required <= 0.3 FiO(2). In the delivery suite, the median (IQR) rcSO(2) in the low and high FiO(2) groups were 81% (66%-86%) and 72% (62%-86%), respectively. Patients in the high FiO2 group had a larger rcSO(2) area below 55% (P = .01). There was a significant difference in rcSO(2) between the groups (P < .05), with the low group having higher rcSO(2) values initially, but this difference changed over time. In the neonatal intensive care unit (NICU), rcSO(2) values were lower by 7.1% (CI 12.13 to 2.06%) P = .008 in the high FiO(2) group.Conclusions Infants given >0.3 FiO(2) had more cerebral hypoxia than infants requiring <= 0.3 FiO(2) but no difference in the degree of cerebral hyperoxia, both in the delivery suite and the NICU. This suggests that a more rapid increase in oxygen titration maybe be required initially for preterm infants.

10.1016/j.jpeds.2015.07.063