Objectives: To investigate the occurrence of peri/intraventricular haemorrhage (P/IVH) in preterm infants and its potential association with cerebral regional oxygen saturation (crSO₂) during the immediate transition. Methods: In this two-centre prospective observational cohort study, crSO₂ was measured with near-infrared spectroscopy in preterm infants (<32 weeks of gestational age) during the immediate neonatal transition (15 min). In addition, arterial oxygen saturation (SpO₂) and heart rate (HR) were monitored with pulse oximetry. Cranial ultrasound scans were performed on day 4, day 7 and day 14 after birth and before discharge. Neonates with IVH of any grade (IVH group) were matched to the neonates without IVH (Non-IVH group) on gestational age (±1 week) and birth weight (±100 g). The duration and magnitude of deviation from the 10th centile in crSO2 during immediate transition was analysed and expressed in %minutes. Results: IVH was found in 12 of the included neonates, who were matched to 12 neonates without IVH. There was no difference in SpO₂ and HR between these two groups. The duration and magnitude of centiles-deviation of crSO₂ was significantly pronounced in the IVH group compared with the Non-IVH group (1870%min vs 456%min). Conclusions: The neonates of the IVH group showed significantly lower crSO₂ values during the immediate transition, although there was no difference concerning SpO₂ and HR. The additional monitoring of crSO₂ during the immediate transition could reveal neonates with higher risk of developing an IVH later in the course.

Background: Non-invasive monitoring of the brain with near-infrared spectroscopy (NIRS) during immediate transition after birth is of growing interest. Objective: The aim of this work was to define reference ranges and centile charts for a regional cerebral tissue oxygenation index (cTOI), measured with the NIRO 200NX (NIRO, Hamamatsu, Japan), and cerebral fractional tissue oxygen extraction (cFTOE) during the first 15 min after birth in preterm and term neonates without any medical support. Methods: cTOI was measured with the NIRO 200NX during the first 15 min after delivery via Caesarean section in preterm and term infants. The NIRS-sensor was placed on the right forehead. Peripheral arterial oxygen saturation (SpO2) and heart rate were continuously measured by pulse oximetry. cFTOE was calculated out of cTOI and SpO2. Neonates with a requirement for any medical support were excluded. Results: A total of 230 neonates were enrolled, from which 90 had to be excluded. Therefore, 140 term neonates were included and data were used to define reference ranges and centile charts. The 50th centile (10th to 90th centiles) of cTOI was 56% (39-75) at 2 min, 66% (50-78) at 5 min, 75% (62-85) at 10 min and 73% (61-84) at 15 min after birth. The 50th centile of cFTOE was 0.24 (0.11-0.44) at 2 min, 0.20 (0.10-0.35) at 5 min, 0.21 (0.09-0.35) at 10 min and 0.24 (0.13-0.37) at 15 min after birth. Conclusion: The present observational study adds the reference ranges and centile charts of cTOI measured with the NIRO 200NX and cFTOE calculated out of cTOI and SpO2 in neonates during the immediate neonatal transition. Centiles for each instrument will be necessary for future clinical application, since the differences between cTOI and cerebral regional tissue oxygen saturation measured with INVOS 5100C change with increasing regional oxygenation.

Sustained lung inflations (SLI) during neonatal resuscitation may promote alveolar recruitment in preterm infants. While most of the studies focus on respiratory outcome, the impact of SLI on the brain hasn’t been investigated yet. Do SLI affect cerebral blood volume (CBV) in preterm infants? Preterm infants of gestation 28 weeks 0 days to 33 weeks 6 days with requirement for respiratory support (RS) were included in this randomized controlled pilot trial. Within the first 15 minutes after birth near-infrared spectroscopy (NIRS) measurements using ‘NIRO-200-NX’ (Hamamatsu, Japan) were performed to evaluate changes in CBV and cerebral tissue oxygenation. Two groups were compared based on RS: In SLI group RS was given by applying 1–3 SLI (30 cmH₂O for 15 s) continued by respiratory standard care. Control group received respiratory standard care only. 40 infants (20 in each group) with mean gestational age of 32 weeks one day (±2 days) and birth weight of 1707 (±470) g were included. In the control group ΔCBV was significantly decreasing, whereas in SLI group ΔCBV showed similar values during the whole period of 15 minutes. Comparing both groups within the first 15 minutes ΔCBV showed a tendency toward different overall courses (p = 0.051). This is the first study demonstrating an impact of SLI on CBV. Further studies are warranted including reconfirmation of the present findings in infants with lower gestational age. Future investigations on SLI should not only focus on respiratory outcome but also on the consequences on the developing brain. German Clinical Trials Register DRKS00005161 https://drks-neu.uniklinik-freiburg.de/drks_web/setLocale_EN.do

Fetal hemoglobin (HbF) is a principal oxygen carrier in the blood of preterm and term neonates. Compared to adult hemoglobin, it has a significantly higher affinity for oxygen and its oxyhemoglobin dissociation curve (ODC) is left-shifted accordingly. Tissue oxygenation measured with near-infrared spectroscopy (NIRS) during neonatal intensive care is directly affected by hemoglobin concentration. We performed a systematic qualitative review regarding the impact of HbF on tissue oxygenation monitoring by NIRS. The PubMed/Medline, EMBASE, Cochrane library and CINAHL databases were searched from inception to May 2021 for studies relating to HbF and NIRS in preterm and term neonates in the first days and weeks after birth. Out of 1,429 eligible records, four observational studies were included. Three studies found no effect of HbF on cerebral tissue oxygenation. One peripheral NIRS study found a positive correlation between HbF and peripheral fractional oxygen extraction (FOE). Currently available limited data suggest that FHbF could affect peripheral muscle FOE, but seems not to affect cerebral oxygenation in preterm neonates. More studies are needed to draw a final conclusion on this matter, especially concerning the oxygenation changes driven by adult RBC transfusions.

Background: Substantial haemodynamic changes occur during the first minutes after birth. Currently, only heart rate (HR) and arterial oxygen saturation are routinely used to monitor haemodynamic transition after birth. Objectives: The aim of the present study was to continuously assess haemodynamic changes during transition in term infants for the first time by using electrical velocimetry (EV), a new method of non-invasive cardiac output monitoring (NICOM), based on impedance cardiography technology. Methods: In this prospective observational study, term neonates delivered by elective caesarean section underwent NICOM measurements within the first 15 min after birth. The beat-to-beat measurement over a 10-second period was used to calculate cardiac output (CO) for each minute after birth. The data of CO were only accepted when the signal quality index (SQI) remained >80% during the measurement period of 10 s. Results: 100 term neonates underwent 1,500 NICOM measurements. 1,143 (76.2%) measurements were excluded because of a SQI <80%. HR and CO showed a trend to increase within the first minutes, and decreased significantly from minute 3 (HR) and 4 (CO), until minute 12 and 10, respectively. Stroke volume remained stable during the observation period. Conclusion: The present study was the first using EV for NICOM during the transition period in a larger cohort of newborn infants. Results of NICOM were similar to available echocardiography data. The possibility of NICOM offers continuous CO measurement. The present study supports the idea that CO is closely related to HR in newborn infants.