title: Effects of Fractional Inspired Oxygen on Cerebral Oxygenation in Preterm Infants following Delivery.
abstract: OBJECTIVE
  To explore regional cerebral oxygen saturations (rcSO2) in preterm neonates initially stabilized with 0.3 fractionated inspired oxygen (FiO2) concentrations. We hypothesized that those infants who received >0.3 FiO2 during stabilization following delivery would have relatively higher rcSO2 postdelivery compared with those stabilized with a lower FiO2.
  
  
  METHODS
  A single center prospective observational study of 47 infants born before 32 weeks. Using near infrared spectroscopy, rcSO2 values were recorded immediately after birth. All preterm infants were initially given 0.3 FiO2 and were divided into 2 groups according to subsequent FiO2 requirements of either ≤0.3 or >0.3 FiO2. Using a mixed-effects model, we compared the difference between the groups over time. Also, the area measures below 55% (hypoxia) and above 85% (hyperoxia) were compared between the groups.
  
  
  RESULTS
  The mean (SD) gestation was 29.4 (1.6) weeks and the mean (SD) weight was 1.3 (0.4) kg. Less than one-half of the infants (20/45; 43%) required ≤0.3 FiO2. In the delivery suite, the median (IQR) rcSO2 in the low and high FiO2 groups were 81% (66%-86%) and 72% (62%-86%), respectively. Patients in the high FiO2 group had a larger rcSO2 area below 55% (P = .01). There was a significant difference in rcSO2 between the groups (P < .05), with the low group having higher rcSO2 values initially, but this difference changed over time. In the neonatal intensive care unit (NICU), rcSO2 values were lower by 7.1% (CI 12.13 to 2.06%) P = .008 in the high FiO2 group.
  
  
  CONCLUSIONS
  Infants given >0.3 FiO2 had more cerebral hypoxia than infants requiring ≤0.3 FiO2 but no difference in the degree of cerebral hyperoxia, both in the delivery suite and the NICU. This suggests that a more rapid increase in oxygen titration maybe be required initially for preterm infants.
authors.affiliation: Department of Pediatrics and Child Health, Neonatal Intensive Care Unit, University College Cork, Cork, Ireland; Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.
authors.forename: Mmoloki
authors.initials: M
authors.lastname: Kenosi
authors.affiliation: Department of Pediatrics and Child Health, Neonatal Intensive Care Unit, University College Cork, Cork, Ireland; Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.
authors.forename: John M
authors.initials: JM
authors.lastname: O'Toole
authors.affiliation: Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.
authors.forename: Vicki
authors.initials: V
authors.lastname: Livingston
authors.affiliation: Department of Pediatrics and Child Health, Neonatal Intensive Care Unit, University College Cork, Cork, Ireland; Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.
authors.forename: Gavin A
authors.initials: GA
authors.lastname: Hawkes
authors.affiliation: Department of Pediatrics and Child Health, Neonatal Intensive Care Unit, University College Cork, Cork, Ireland; Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.
authors.forename: Geraldine B
authors.initials: GB
authors.lastname: Boylan
authors.affiliation: Department of Physiology, School of Medicine, University College Cork, Cork, Ireland.
authors.forename: Ken D
authors.initials: KD
authors.lastname: O'Halloran
authors.affiliation: Department of Pediatrics and Child Health, Neonatal Intensive Care Unit, University College Cork, Cork, Ireland; Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Ryan
authors.affiliation: Department of Pediatrics and Child Health, Neonatal Intensive Care Unit, University College Cork, Cork, Ireland; Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland. Electronic address: gene.dempsey@hse.ie.
authors.forename: Eugene M
authors.initials: EM
authors.lastname: Dempsey
mesh_terms: D001724:Birth Weight; D001921:Brain / Q000473:pathology; D002560:Cerebrovascular Circulation; D005260:Female; D005865:Gestational Age; D006801:Humans; D018496:Hyperoxia; D000860:Hypoxia; D007231:Infant, Newborn; D007234:Infant, Premature; D015931:Intensive Care, Neonatal; D008297:Male; D010092:Oximetry / Q000379:methods; D010100:Oxygen / Q000627:therapeutic use*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D019265:Spectroscopy, Near-Infrared
chemical_list: D010100:Oxygen