The hidden consequence of intraventricular hemorrhage (IVH): persistent cerebral desaturation after IVH in preterm infants

BACKGROUND: Previous studies describe a short-term decrease in cerebral oxygen saturation (StO2) after intraventricular hemorrhage (IVH) in premature infants; little is known about long-term implications. METHODS: Infants born <30 weeks gestational age (GA) were included. Clinical characteristics, hemoglobin measurements, highest grade of IVH, and white matter injury (WMI) were noted. NIRS monitoring occurred daily or every other day for four weeks; weekly through 36 weeks GA. Recordings were error-corrected before calculation of mean StO2 and fractional tissue oxygen extraction (FTOE). Mean StO2 and FTOE were plotted by postnatal age and injury group (IVH/no IVH; WMI/no WMI). Non-linear regression by locally-estimated scatterplot smoothing was used to generate the best-fit line and CI. RESULTS: 1237 recordings from 185 infants were included; mean length=6.5h; mean GA=26.3w; mean BW=951g; overall/severe IVH incidence was 29/8%, WMI incidence was 16%. IVH was independently associated with an acute drop in StO2 which remained lower for 68d. Severe IVH was associated with lower StO2 values than mild IVH. WMI was associated with early and persistent elevation of FTOE. CONCLUSION: IVH of any grade is associated with a prolonged cerebral desaturation, WMI is associated with prolonged elevation of FTOE. This finding is exacerbated for infants with severe IVH.