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Association between cerebral oxygen saturation and brain injury in neonates receiving therapeutic hypothermia for neonatal encephalopathy

Journal of Perinatology volume 41, pages 269–277 (2021)Cite this article

Subjects

Abstract

Objective

To assess the association of cerebral oxygen saturation (CrSO2) collected by near infrared spectroscopy (NIRS) during therapeutic hypothermia (TH) and rewarming with evidence of brain injury on post-rewarming MRI.

Study design

This retrospective cohort study included 49 infants, who received TH for mild to severe neonatal encephalopathy. Of those, 26 presented with brain injury assessed by a novel MRI grading system, whereas 23 had normal MRI scans.

Results

CrSO2 increased significantly from the first to the second day of TH in infants with brain injury, whereas it remained stable in patients with normal MRI. Increasing mean CrSO2 values during rewarming was associated with brain injury (aOR 1.14; 95% CI 1.00–1.28), specifically with gray matter (GM) injury (aOR 1.23; 95% CI 1.02–1.49). The area under the ROC curve showed an excellent discrimination for GM involvement.

Conclusion

Clinically applied NIRS during TH and rewarming can assist in identifying the risk for brain injury.

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Fig. 1: The changes of cerebral oxygen saturation over time in infants with and without brain injury.

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Author information

Authors and Affiliations

  1. Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Eniko Szakmar, Jennifer Smith, Joseph J. Volpe, Terrie Inder & Mohamed El-Dib

  2. 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary

    Eniko Szakmar

  3. Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Edward Yang

  4. Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Joseph J. Volpe

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Contributions

ES had substantial contributions to conception and design, data analysis, and interpretation of data. She also drafted the article and had final approval of the version to be published. JS helped to collect and analyze the data and to write the manuscript draft. EY and TI analyzed MRI imaging studies, supervised the interpretation of data and revised the manuscript. JJV had substantial contributions to conception and interpretation of data, and revised the manuscript for important intellectual content. ME conceptualized and designed the study, supervised all aspects and critically reviewed the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Mohamed El-Dib.

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Conflict of interest

ES, TI, and ME-D received an External Research Grant from Medtronic, Inc to support a clinical study not related to the work presented in this manuscript. The authors have no financial relationships relevant to this article to disclose.

Ethics approval and consent to participate

This study was approved by the Partners Human Research Committee Institutional Review Board and consent was waived (IRB protocol# 2014P002430).

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Szakmar, E., Smith, J., Yang, E. et al. Association between cerebral oxygen saturation and brain injury in neonates receiving therapeutic hypothermia for neonatal encephalopathy. J Perinatol 41, 269–277 (2021). https://doi.org/10.1038/s41372-020-00910-w

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