Cerebral Oxygenation-Guided Resuscitation and MRI Outcomes In Preterm Neonates

Key Takeaways

• In preterm infants, MRI-defined brain injury incidence did not differ between NIRS-guided and control groups.
• The NIRS group showed a larger biparietal diameter, with a reported trend toward fewer abnormal biparietal diameter findings.
• The investigators concluded that crSO2 monitoring did not change MRI-assessed brain injury, while the meaning of the larger biparietal diameter remains unresolved.

In a secondary MRI analysis from the multicenter randomized phase 3 COSGOD III trial, investigators evaluated 172 very preterm infants assigned to near-infrared spectroscopy-based cerebral oxygen saturation-guided resuscitation during immediate postnatal transition or standard care alone.

This secondary outcome analysis included 86 infants per group from five participating centers. The cohort had a median gestational age of 28.4 weeks and a median birth weight of 1045 g. The intervention used cerebral oxygen saturation guidance by near-infrared spectroscopy with dedicated treatment guidelines during immediate postnatal transition, while controls received standard care alone. At participating centers, near-term MRI outcomes covered intraventricular hemorrhage, cerebellar hemorrhage, white matter injury, transcerebellar diameter, biparietal diameter, and interhemispheric distance.

Across the MRI cohort, the incidence of brain injury did not differ between the NIRS-guided and control groups. The clearest separation in the abstract involved biparietal diameter, which was larger in the monitored group. Median biparietal diameter was 78.6 mm, with an interquartile range of 76.3 to 82.1, versus 76.7 mm, with an interquartile range of 74.7 to 80.0, in controls. Researchers also observed a trend toward a lower rate of abnormal biparietal diameter in the NIRS group.

The investigators concluded that crSO2 monitoring with dedicated treatment guidelines had no effect on MRI-assessed brain injury. They described the larger biparietal diameter as a possible sign of enhanced brain development rather than established clinical benefit. The relationship between this structural finding and long-term functional outcomes still requires further investigation.