Background: In the clinical setting, episodes of desaturation in newborn infants are often treated by increasing the fraction of inspired oxygen (FiO2). Objectives: To study the effect of an increase in FiO2 on cerebral oxygenation during recovery from desaturation, as measured by near-infrared spectroscopy (NIRS). Methods: Peripheral arterial saturation (SaO2), NIRS-monitored cerebral saturation (rScO2), and fractional cerebral oxygen extraction (cFTOE) were analyzed in the first 3 days of life during 6 episodes of desaturation (SaO2 <75%, >30 s) in each of 24 otherwise stable spontaneously breathing preterm infants (gestational age 29.8 ± 1.5 weeks, birth weight 1,215 ± 280 g; mean ± SD), during 3 episodes without and 3 episodes with increased FiO2 during recovery from desaturation. Results: Post-recovery SaO2 with increased FiO2 was significantly higher than post-recovery SaO2 without increased FiO2. Post-recovery SaO2 and rScO2 were significantly increased over baseline saturations when FiO2 was increased. Post-recovery rScO2 was very high for several minutes in some cases, while cFTOE was highly suggestive of oxygen delivery that exceeded consumption. Conclusions: Assuming that NIRS-measured rScO2 is an indicator of cerebral oxygen content, an increase in FiO2 to assist recovery from desaturation may cause hyperoxygenation of the brain in relatively stable preterm infants. This procedure may be particularly harmful in the sick very preterm infant with limited regulation of brain circulation and poorly developed antioxidant defenses.

Keywords:
Apnea, Near-infrared spectroscopy, Cerebral oxygenation
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© 2010 S. Karger AG, Basel
2010
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