Abstract
Objective Hypoxic-ischemic encephalopathy (HIE) affects millions of newborns annually, especially
in low-resource settings. Real-time monitoring of hypoxic-ischemic brain damage is
urgently needed for assessment of severity and management of neonates with birth asphyxia.
Aim of the work is monitoring of near-infrared spectroscopy (NIRS)-measured cerebral
regional oxygen saturation (cRSO2) and cerebral fractional tissue oxygen extraction (FTOE) in neonates after birth asphyxia
in relation to their clinical course.
Study Design Forty asphyxiated-term and near-term neonates with mild to severe HIE admitted at
neonatal intensive care unit of Alexandria University Maternity Hospital from March
to October 2019, received therapeutic hypothermia (TH) and had continuous NIRS monitoring
of cRSO2 for 72 hours. Infants were categorized into HIE with seizing and nonseizing groups,
and abnormal and normal magnetic resonance imaging (MRI) groups.
Results Clinical seizures (CS) occurred in 15 (37.5%) of HIE neonates and 13.3% of them died
(n = 2). In the current study, significantly higher cRSO2 and lower FTOE values were found in the seizing infants as compared with nonseizing
group (p < 0.001). NIRS-measured day 2-cRSO2 and day 1-FTOE were associated with CS in newborns with HIE and day 1-cRSO2 and FTOE were associated with abnormal MRI at 1 month of age. cRSO2 values were found to correlate positively with initial Thompson score especially
in days 1 and 2. Further, neonates with CS were more likely to have MRI abnormalities
at follow-up.
Conclusion NIRS measures may highlight differences between asphyxiated neonates who develop
CS or later MRI abnormalities and those who do not.
Key Points
-
Day 1 FTOE is the early and sensitive predictor for both clinical seizures and abnormal
MRI.
-
Cerebral oxygenation metrics help in selecting patients in urgent need of an early
MRI scan.
-
Cerebral oxygenation metrics can be used hand in hand with clinical assessment using
Thompson score at admission to select patient candidate for therapeutic hypothermia.
Keywords
hypoxic-ischemia - therapeutic hypothermia - clinical seizures - near-infrared spectroscopy
- cRSO
2
- FTOE
