NEW ZEALAND (2021)
EARLY CEREBRAL HYPOXIA IS ASSOCIATED WITH ABNORMAL MOTOR PATTERNS IN EXTREMELY LOW BIRTH WEIGHT INFANTS
Meghan Sandle1,2, Maria Saito-Benz1,2, Karen Bennington1, Nathalie DeVries2,3, Max J. Berry1,2
1Wellington Neonatal Unit, Capital and Coast District Health Board, New Zealand; 2Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand; 3Department of Child Health, MidCentral District Health Centre, Palmerston North, New Zealand
Background: Cerebral regional hypoxia has been implicated in the development of preterm-associated neurological injuries1, however, the duration of cerebral hypoxia which places infants at risk of later neurodevelopmental disability is currently unknown. Non-invasive and real-time monitoring of cerebral regional oxygenation by Near Infrared Spectroscopy (NIRS) offers potential targets for clinical intervention. The general movement assessment (GMA) during early infancy is a reliable marker of later neurodevelopment outcome, particularly Cerebral Palsy, and reduced motor optimality scores at 3-5 months corrected postnatal age are associated with higher risk of neurodevelopmental disabilitiy2.
Aim: This study aimed to investigate associations between early cerebral hypoxia burdens and GMA in extremely low birth weight (ELBW) infants.
Methods: Thirty-three infants born < 30 weeks gestation and < 1000 grams birth weight were prospectively recruited in Wellington Neonatal Intensive Care Unit between January 2018 and April 2019. Cerebral regional oxygenation (crSO2) was measured using NIRS (INVOS 5100c, Medtronic) for 72 hours after birth. In the current study crSO2 < 63% (two standard deviations below the mean for gestational age3) was considered significant cerebral regional hypoxia. GMA, including motor optimality score was performed at 12-16 weeks corrected age.
Results: Follow-up data is available for thirty-two surviving infants with mean gestational age of 25+6 weeks (range:23+0-29+5) and birth weight of 741 grams (range 505-998). CrSO2 < 63% for more than one cumulative hour in the first 72 hours of life was associated with suboptimal GMA optimality scores (< 25) (p = 0.04). A negative linear correlation was observed between time spent with crSO2 <63% and GMA optimality score (r2 =0.136 p = 0.04).
Conclusions: Our findings suggest that cumulative cerebral hypoxia for greater than one hour in the first 72 hours increases risk of later neurodevelopmental disability for ELBW infants. Furthermore, the duration of cerebral hypoxia burden was directly and negatively correlated with lower GMA optimality scores, indicating poorer neurodevelopmental outcomes. Therefore, the role of NIRS to monitor cerebral regional oxygenation to enable clinical intervention and reduce cerebral hypoxia burden in this high risk cohort warrants further investigation.
References:
1. Alderliesten T, Van Bel F, Van Der N, Steendijk P, Van Haastert C, De Vries L, et al. Low cerebral oxygenation in preterm infants is associated with adverse neurodevelopmental outcome. Journal of Pediatrics. 2019;207:109–116.
2. Einspieler C, Bos A, Krieber-Tomantschger M, Alvarado E, Barbosa V, Bertoncelli N, et al. Cerebral Palsy: Early Markers of Clinical Phenotype and Functional Outcome. Journal of Clinical Medicine. 2019;8(10):1616.
3. Kleiser S, Ostojic D, Andersen B, Nasseri N, Isler H, Scholkmann F, et al. Comparison of tissue oximeters on a liquid phantom with adjustable optical properties: an extension. Biomedical Optics Express. 2018;9(1):86–101.
