Am J Perinatol
DOI: 10.1055/s-0041-1736533
Original Article

Decreased Cerebral Oxygenation in Premature Infants with Progressive Posthemorrhagic Ventricular Dilatation May Help with Timing of Intervention

Angelina June
1  Department of Pediatrics, Eastern Virginia Medical School, Children's Hospital of King's Daughters, Norfolk, Virginia
,
Timothy Heck
1  Department of Pediatrics, Eastern Virginia Medical School, Children's Hospital of King's Daughters, Norfolk, Virginia
,
Tushar A. Shah
2  Division of Neonatal–Perinatal Medicine, Department of Pediatrics, Eastern Virginia Medical School, Children's Hospital of King's Daughters, Norfolk, Virginia
,
Turaj Vazifedan
3  Division of Biostatistics, Department of Pediatrics, Eastern Virginia Medical School, Children's Hospital of King's Daughters, Norfolk, Virginia
,
William Thomas Bass
2  Division of Neonatal–Perinatal Medicine, Department of Pediatrics, Eastern Virginia Medical School, Children's Hospital of King's Daughters, Norfolk, Virginia
› Author Affiliations
Financial Support The study was supported by the Division of Neonatal-Perinatal Medicine and the Children's Hospital of The King's Daughters, and received no external funding.

Abstract

Objective The objective of this study was to determine the degree of progressive posthemorrhagic ventricular dilatation (PHVD) that is associated with a significant decrease in regional cerebral oxygen saturation (rScO2) in premature infants at risk for periventricular–intraventricular hemorrhage (PIVH).

Study Design Cranial ultrasound (US) and near-infrared spectroscopy (NIRS) measurements of rScO2 were performed on inborn infants with birth weights less than 1,250 g on admission and at 1, 4, and 8 weeks of age. Infants with severe PIVH were studied weekly. A 1-hour average of rScO2 was compared with the frontal–occipital horn ratio (FOHR) measured the same day. Generalized linear models were used to analyze the relationship between FOHR and rScO2, by severity of PIVH, and adjusted for gestational age. Cut-off points of 0.55 for FOHR and 45% for rScO2 were used to calculate odds ratios (OR) and 95% confidence intervals (CI).

Results The study cohort included 63 infants with normal US, 15 with grade-1 or -2 PIVH (mild group), and 21 with grade-3 or -4 PIVH (severe group). Increases in FOHR in the severe group were associated with decreases in rScO2 at 1 week (p = 0.036), 4 weeks (p = 0.013), and 8 weeks of life (p = 0.001) compared with the normal and mild groups. Infants with FOHR greater than 0.55 were 92% more likely to have rScO2 less than 45% when compared with infants with FOHR less than 0.55 (OR = 0.08, 95% CI: [0.04, 0.13], p < 0.001).

Conclusion Progressive PHVD (FOHR > 0.55) is a strong predictor of compromised cerebral oxygenation. A combination of rScO2 and FOHR measurements may aid in identifying infants with PHVD that would benefit from early intervention.

Key Points

  • Earlier intervention in PHVD may improve outcomes.

  • PHVD is diagnosed with US measurements of ventricular size.

  • FOHR > 0.55 is associated with decreased cerebral perfusion.



Publication History

Received: 02 August 2021

Accepted: 13 September 2021

Publication Date:
21 October 2021 (online)

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