261 - Patterns Of Early Cerebral Oxygenation In Preterm Infants During Optimal Cord Management: Observations From The COSMIC Pilot Study

Publication Number: 4257.261

Arangan Kirubakaran, Imperial College Healthcare NHS Trust, Croydon, England, United Kingdom; Silvia Artusa, Imperial College Healthcare NHS Trus t, London, England, United Kingdom; Nicolette Wong, Imperial College London, London, England, United Kingdom; Bineta Lahr, University Medical Center Groningen, Groningen, Groningen, Netherlands; Christine J. Lim, Imperial college healthcare NHS trust, London, England, United Kingdom; Rania S. Selim, Oxford University Hospitals, Oxford, England, United Kingdom; Jayanta Banerjee, Imperial College London, London, England, United Kingdom; Aniko Deierl, Imperial College Healthcare NHS Trust, Harrow, England, United Kingdom

Background: Optimum cord management is of great interest to neonatologists with evidence suggesting reduction mortality and brain injury in preterm infants. Near-Infrared Spectroscopy (NIRS) provides a non-invasive, real-time method for monitoring regional cerebral oxygenation saturation (rCSO2) during the neonatal transition. Most existing evidence derives from late preterm or term babies, often with variable cord clamping practices.

Objective: We conducted a pilot observational study using NIRS to measure CrSO2 immediately after birth in preterm infants, and comparing between gestational age (GA) categories of < 28 weeks and > 28 weeks during optimum cord management in delivery room (DR).

Design/Methods: This prospective observational study was conducted in a tertiary neonatal unit in Londen and prospectively included infants born with a GA < 34+0. Written deferred parental consent was obtained. A NIRS probe (INVOS 7100) was attached to the left forehead immediately after birth, prior to cord clamping, and rCSO2 was recorded continuously for the first 15 minutes after birth. For each infant, average rCSO₂ was calculated per minute, and group-level medians and interquartile ranges were computed for each minute to compare infants with GA < 28 weeks and >28 weeks.

Results: Nineteen preterm infants recruited, 11 with GA >28 weeks (median 31+4 weeks, range 29+0-33+5 weeks) and 8 with GA < 28 weeks (median 26+6 weeks, range 24+6- 28+0 weeks), demonstrated a significant difference between GA groups (p < 0.001). Median birth weight (BW) was 1427 g (range 686-1980) in infants >28 weeks and 908g (range 550-1030) in infants < 28 weeks (p = 0.007). rCSO₂ measurements for the entire cohort over the first 15 minutes after birth are shown in Figure 1. Infants with GA < 28 weeks had significantly lower rCSO2 at minutes 3-7 and 10-11 compared with infants with GA >28 weeks (Figure 2). Timing of cord clamping did not differ between groups (median 60 s, range 0-90s in >28 weeks; range 0-100s in < 28 weeks; p = 0.5).

Conclusion(s): Preterm infants with GA < 28 weeks exhibit lower cerebral oxygenation trajectory in the first minutes after birth compared with more mature infants, despite similar cord clamping. These findings highlight the cardiovascular vulnerability of extremely preterm infants and support the potential utility of NIRS for real-time monitoring to guide early neonatal care.

Figure 1:
Median and IQR of cerebral oxygen saturation (rCSO₂) in preterm infants during the first 15 minutes after birth. rCSO₂ measurements for all included preterm infants (n = 19) were averaged per minute and plotted as group medians. The shaded area represents the interquartile range for the entire cohort.

Figure 2
Comparison of cerebral oxygen saturation (rCSO₂) in preterm infants with gestational age <28 weeks and >28 weeks during the first 15 minutes after birth. rCSO₂ measurements were averaged per minute for each infant, and group medians with interquartile ranges (IQR) are shown. Infants with GA <28 weeks (blue, n = 8) had significantly lower rCSO₂ at minutes 3-7 and 10-11 compared with infants with GA >28 weeks (red, n = 11). *P < 0.05.