Early cerebral oxygen extraction and the risk of death or sonographic brain injury in very preterm infants

J Pediatr. 2014 Mar;164(3):475-80.e1. doi: 10.1016/j.jpeds.2013.10.041. Epub 2013 Dec 19.


Objective: To evaluate the relationship between cerebral fractional tissue oxygen extraction (cFTOE), a measure of oxygen delivery-consumption equilibrium, and the risk of early poor outcome in very preterm infants.

Study design: Cerebral blood flow, tissue oxygenation index (by near-infrared spectroscopy), and arterial oxygen content were measured, and cerebral oxygen delivery, consumption, and cFTOE were calculated at 3 intervals in the first 72 hours of life in infants ≤ 30 weeks gestational age (GA). A receiver operating characteristic curve was derived with an a priori defined dichotomized outcome of good or poor, defined as death or sonographic brain injury (grade ≥ II intraventricular hemorrhage) by day 7.

Results: Seventy-one infants were enrolled, with a mean (SD) GA of 27 (2) weeks. cFTOE demonstrated better discrimination for the study outcome at <24 hours of age than at 48 or 72 hours of age (P = .01). The area under the curve for cFTOE at the initial measurement was no different from that for GA alone (0.87; 95% CI, 0.77-0.95 vs 0.81; 95% CI, 0.69-0.92), but the combined measure of cFTOE and GA had better discrimination (0.96; 95% CI, 0.91-1.0) than either cFTOE (P = .03) or GA (P = .016) alone. A cFTOE of 0.4 had a sensitivity of 82% and specificity of 75% for risk of early poor outcome.

Conclusion: Elevated cFTOE values are associated with increased risk of early poor outcome in very preterm infants. Its predictive value is further improved with the addition of GA.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Carotid Artery, Internal / diagnostic imaging
  • Cerebral Hemorrhage / diagnostic imaging*
  • Cerebrovascular Circulation*
  • Echocardiography
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Infant, Premature*
  • Infant, Premature, Diseases / diagnostic imaging
  • Logistic Models
  • Oximetry / methods*
  • Oxygen / blood*
  • ROC Curve
  • Regional Blood Flow
  • Respiration, Artificial / statistics & numerical data
  • Sensitivity and Specificity
  • Spectroscopy, Near-Infrared
  • Ultrasonography, Doppler, Pulsed


  • Oxygen