Cerebral oximetry monitoring in preterm infants does not reduce death or brain injury risk: NEJM

Denmark: A new study published in the New England Journal of Medicine has found that the use of cerebral oximetry monitoring in the care of extremely preterm infants does not lower the incidence of death or severe brain injury.

Monitoring with cerebral oximetry is becoming more common in the management of extremely preterm newborns. However, there is no evidence that its use improves clinical results.

The randomized, phase 3 trial was conducted at 70 sites in 17 countries and included 1601 infants with a gestational age of fewer than 28 weeks, randomized the infants to receive either treatment guided by cerebral oximetry monitoring for the first 72 hours after birth or usual care.

The primary outcome was a composite of death or severe brain injury on cerebral ultrasonography at 36 weeks postmenstrual age. Death, severe brain injury, bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, and late-onset sepsis were all considered serious adverse events.

The study revealed the following clinical findings:

1. At 36 weeks postmenstrual age, death or severe brain injury occurred in 35.2% of infants in the cerebral oximetry group and 34.0% in the usual care group.

2. The relative risk with cerebral oximetry was 1.03 with a 95% confidence interval of 0.90 to 1.18 and a p-value of 0.64.

3. The incidence of serious adverse events did not differ between the two groups

The findings of this study suggest that cerebral oximetry monitoring may not be necessary for the care of extremely preterm infants. However, further research is needed to determine whether it may be beneficial in other patient populations.

The researchers of the study added that “Healthcare providers should carefully consider the risks and benefits of cerebral oximetry monitoring when caring for preterm infants. This study provides important new information that will help guide clinical practice in the care of preterm infants.”

Reference:

Hansen M., Pellicer A., Hyttel-Sørensen S., Ergenekon E., et al; Cerebral Oximetry Monitoring in Extremely Preterm Infants; N Engl J Med 2023; 388:1501-1511; DOI: 10.1056/NEJMoa2207554