Neonatal Med.  2021 Feb;28(1):14-21. 10.5385/nm.2021.28.1.14.

Cerebral Oxygenation during Apnea in Preterm Infants: Effects of Accompanying Peripheral Oxygen Desaturation

Affiliations
  • 1Department of Pediatrics, Inha University Hospital, Incheon, Korea
  • 2Department of Pediatrics, Inha University College of Medicine, Incheon, Korea
  • 3Department of Pediatrics, Seoul National University Children’s Hospital, Seoul, Korea

Abstract

Purpose
Premature infants have immature respiratory control and cerebral autoregulation. We aimed to investigate changes in cerebral oxygenation during apnea with and without peripheral oxygen desaturation in premature infants.
Methods
This prospective observational study was conducted at Inha University Hospital. Near-infrared spectroscopy (NIRS)-monitored regional cerebral oxygen saturation (rScO2) and pulse oximeter-monitored peripheral oxygen saturation (SpO2) were assessed during the first week of life in 16 stable, spontaneously breathing preterm infants. Apneic episodes that lasted for ≥20 seconds or were accompanied by desaturation or bradycardia were included for analysis. The average rScO2 value during the 5-minute prior to apnea (baseline), the lowest rScO2 value following apnea (nadir), the time to recover to baseline (recovery time), the area under the curve (AUC), and the overshoot above the baseline after recovery were analyzed.
Results
The median gestational age and birth weight of the infants were 29.2 weeks (interquartile range [IQR], 28.5 to 30.5) and 1,130 g (IQR, 985 to 1,245), respectively. A total of 73 apneic episodes were recorded at a median postnatal age of 2 days (IQR, 1 to 4). The rScO2 decreased significantly following apneic episodes regardless accompanied desaturation. There were no differences in baseline, nadir, or overshoot rScO2 between the two groups. However, the rScO2 AUC for apnea with desaturation was significantly higher than that for apnea without desaturation.
Conclusion
Cerebral oxygenation can significantly decrease during apnea, especially when accompanied by reduced SpO2. These results add the evidence for the clinical utility of NIRS in monitoring premature infants.

Keyword

Spectroscopy, near-infrared; Infant, premature; Apnea

Figure

  • Figure 1. Representative tracing of regional cerebral oxygen saturation (rScO2) during an apneic episode, demonstrating the values, time frames, and points of interest used for the analysis during apneic episodes. Baseline: average rScO2 during the 5 minutes before the apneic episode; nadir: the lowest value of rScO2 during the 5 minutes after the onset of apnea; recovery time: time to recover to baseline rScO2; area under the curve (AUC): area of the difference from baseline during recovery; overshoot: the highest value of rScO2 after recovery of rScO2.

  • Figure 2. Box plots of cerebral oxygen saturation (rScO2) during apnea with and without peripheral desaturation. According to the repeated-measures analysis of variance, although rScO2 decreased significantly following apnea in both groups (F=382.4, P<0.001), there was no difference between the two groups (F=2.71, P=0.104).


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