Published online February 1, 2006
PEDIATRICS Vol. 117 No. 2 February 2006, pp. 333-339 (doi:10.1542/peds.2005-0987)

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Cerebral Oxygenation and Electrical Activity After Birth Asphyxia: Their Relation to Outcome

Mona C. Toet, MD^a, Petra M.A. Lemmers, MD^a, Leonard J. van Schelven^b and Frank van Bel, MD, PhD^a

^a Neonatology
^b Biomedical Engineering, University Medical Center Utrecht/Wilhelmina Children’s Hospital, Utrecht, Netherlands

OBJECTIVE. To determine the value of regional cerebral oxygen saturation (rSO₂), fractional cerebral tissue oxygen extraction (FTOE) measured by near-infrared spectroscopy (NIRS), and amplitude integrated electroencephalogram (aEEG) after birth asphyxia in relation to neurodevelopmental outcome.

METHODS. NIRS measured rSO₂, FTOE, and aEEG were monitored simultaneously, together with arterial oxygen saturation (SaO₂) and blood pressure during the first 48 hours after severe birth asphyxia in 18 term infants. FTOE was calculated as [SaO₂ – rSO₂]/SaO₂. Neurodevelopmental outcome was assessed at 3, 9, and 18 months and 3 and 5 years of age. At the time points 6, 12, 18, 24, 30, 36, 42, and 48 hours after birth, the mean values of SaO₂, rSO₂, FTOE, and mean arterial blood pressure were calculated over a 1-hour period. A stepwise-regression model was used to investigate the relative contribution of rSO₂, FTOE, or aEEG to developmental outcome.

RESULTS. Nine Infants died during the neonatal period as a result of neurologic deterioration, and 8 infants had a normal outcome at 5 years of age. One child developed learning disabilities and a mild diplegia. The rSO₂ and FTOE remained stable in infants with a normal outcome. The rSO₂ increased and the FTOE decreased after 24 hours in the infants with an adverse outcome. (rSO₂: 65% vs 84% at 12 and 48 hours, respectively; FTOE: 0.32 vs 0.12 at 12 and 48 hours, respectively). aEEG showed the closest relationship with outcome, but also rSO₂ showed a significant correlation 24 hours after birth.

CONCLUSIONS. rSO₂ and FTOE seem to reflect secondary energy failure. aEEG showed the closest relationship with outcome after severe birth asphyxia.

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Key Words: birth asphyxia • cerebral oxygen saturation • fractional cerebral oxygen extraction • aEEG • neurodevelopmental outcome

Abbreviations: HIE—hypoxic-ischemic encephalopathy • aEEG—amplitude integrated electroencephalogram • NIRS—near-infrared spectroscopy • rSO₂—regional cerebral oxygen saturation • SaO₂—arterial oxygen saturation • FTOE—fractional cerebral tissue oxygen extraction • FT—flat tracing • CLV—continuous extremely low voltage • BS—burst suppression • DNV—discontinuous normal voltage • CNV—continuous normal voltage • MABP—mean arterial blood pressure

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Accepted Jun 27, 2005.

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