Cerebral Oxygen Changes in Neonates During Immediate Transition After Birth and Early Life: An Observational Study

Abstract

Purpose

The physiologic transition from a fetus to a neonate is composed of a series of complex processes that include changes in cerebral tissue oxygenation saturation (cSO₂). Monitoring this process is of great importance. This study aimed to define the cSO₂ reference interval in neonates without medical support, extending the measurements until 1 hour after birth, and to determine the incidence of abnormally low or high regional cerebral oxygenation during the neonatal transition.

Patients and Methods

A total of 418 neonates delivered by cesarean section were enrolled. Near-infrared spectroscopy was used to monitor cerebral oxygenation.

Results

We found that cSO₂ of the non-oxygen-inhaled intrathecal anesthesia in neonates without medical support increased from about 49.0% in the second minute. Most of them reached cSO₂ relative stabilization at 55.7–81.0% between 7 and 8 minutes after birth. One hour after birth, newborn cSO₂ was maintained at 78.0–87.0%. The low cSO₂ rate among babies born under intrathecal anesthesia with and without maternal oxygen inhalation during cesarean sections was approximately 4.5% and 9.0%, respectively.

Conclusion

We reported the trend in cSO₂ from 2 minutes after birth to 1 hour in the neonatal nursing room and determined the incidence of abnormal regional cSO₂ during this neonatal transition period. Anesthesiologists should pay special attention to the risk of cSO₂ abnormalities in newborns when managing pregnant women with comorbidities.

Keywords:

• cerebral oxygenation saturation
• transitional period after birth
• cesarean section
• anesthetic monitoring

Abbreviations

ASA, American Society of Anesthesiologists; SpO2, arterial oxygen saturation; BP, blood pressure; cSO2, cerebral oxygenation saturation; CI, confidence interval; Eph, Ephedrine; GA, general anesthesia; HR, heart rate; IUGR, intrauterine growth restriction; IA, intrathecal anesthesia; NIRS, Near-infrared spectroscopy; NOI neonates, non-oxygen-inhaled intrathecal anesthesia neonates; NOIAWM, non-oxygen-inhaled intrathecal anesthesia neonates without medical support; OR, operating room; OIA neonates, Oxygen-inhaled intrathecal anesthesia neonates; PMA, postmenstrual age; Phe, Phenylephrine; PIH, pregnancy-induced hypertension; SO2, saturation of oxygen; THb, total hemoglobin.

Ethical Requirements

The information obtained was considered confidential, and it was not shared with any third party.

Disclosure

The authors declare that they have no conflict of interest.