Coupling between Regional Oxygen Saturation of the Brain and Vital Signs during Immediate Transition after Birth

Introduction: The primary aim was to analyze any coupling of heart rate (HR)/arterial oxygen saturation (SpO(2)) and regional cerebral oxygen saturation (rScO(2)) and regional cerebral fractional tissue oxygen extraction (cFTOE) during immediate transition after birth in term and preterm neonates to gain more insight into interactions. Methods: The present study is a post hoc analysis of data from 106 neonates, obtained from a prospective, observational study. Measurements of HR, SpO(2), rScO(2), and cFTOE were performed during the first 15 min after birth. The linear and nonlinear correlation were computed between these parameters in a sliding window. The resulting coupling curves were clustered. After clustering, demographic data of the clusters were de-blinded and compared. Results: Due to missing data, 58 out of 106 eligible patients were excluded. Two clusters were obtained: cluster 1 (N = 39) and cluster 2 (N = 9). SpO(2) had linear and nonlinear correlations with rScO(2) and cFTOE, whereby the correlations with rScO(2) were more pronounced in cluster 2. HR-rScO(2) and HR-cFTOE demonstrated a nonlinear correlation in both clusters, again being more pronounced in cluster 2, whereby linear correlations were mainly absent. After de-blinding, the demographic data revealed that the neonates in cluster 2 had significantly lower gestational age (mainly preterm) compared to cluster 1 (mainly term). Discussion: Besides SpO(2), also HR demonstrated a nonlinear correlation with rScO(2) and cFTOE in term and preterm neonates during immediate transition after birth. In addition, the coupling of SpO(2) and HR with cerebral oxygenation was more pronounced in neonates with a lower gestational age.