Cerebral and Peripheral Regional Oxygen Saturation during Postnatal Transition in Preterm Neonates

OBJECTIVE:

To evaluate peripheral regional oxygen saturation (rpSO(2)) and cerebral regional oxygen saturation (rcSO(2)) 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 rpSO(2) and rcSO(2). These variables were measured during the first 15 minutes of life after elective cesarean delivery. Peripheral oxygen saturation (SpO(2)) 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 SpO(2) 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. SpO(2), rcSO(2), and rpSO(2) 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 rpSO(2), rcSO(2), 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.