Early oxygen levels contribute to brain injury in extremely preterm infants

Krista Rantakari*, Olli Pekka Rinta-Koski, Marjo Metsäranta, Jaakko Hollmén, Simo Särkkä, Petri Rahkonen, Aulikki Lano, Leena Lauronen, Päivi Nevalainen, Markus J. Leskinen, Sture Andersson

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

19 Citations (Scopus)
49 Downloads (Pure)


Background: Extremely low gestational age newborns (ELGANs) are at risk of neurodevelopmental impairments that may originate in early NICU care. We hypothesized that early oxygen saturations (SpO2), arterial pO2 levels, and supplemental oxygen (FiO2) would associate with later neuroanatomic changes. Methods: SpO2, arterial blood gases, and FiO2 from 73 ELGANs (GA 26.4 ± 1.2; BW 867 ± 179 g) during the first 3 postnatal days were correlated with later white matter injury (WM, MRI, n = 69), secondary cortical somatosensory processing in magnetoencephalography (MEG-SII, n = 39), Hempel neurological examination (n = 66), and developmental quotients of Griffiths Mental Developmental Scales (GMDS, n = 58). Results: The ELGANs with later WM abnormalities exhibited lower SpO2 and pO2 levels, and higher FiO2 need during the first 3 days than those with normal WM. They also had higher pCO2 values. The infants with abnormal MEG-SII showed opposite findings, i.e., displayed higher SpO2 and pO2 levels and lower FiO2 need, than those with better outcomes. Severe WM changes and abnormal MEG-SII were correlated with adverse neurodevelopment. Conclusions: Low oxygen levels and high FiO2 need during the NICU care associate with WM abnormalities, whereas higher oxygen levels correlate with abnormal MEG-SII. The results may indicate certain brain structures being more vulnerable to hypoxia and others to hyperoxia, thus emphasizing the role of strict saturation targets. Impact: This study indicates that both abnormally low and high oxygen levels during early NICU care are harmful for later neurodevelopmental outcomes in preterm neonates.Specific brain structures seem to be vulnerable to low and others to high oxygen levels.The findings may have clinical implications as oxygen is one of the most common therapies given in NICUs.The results emphasize the role of strict saturation targets during the early postnatal period in preterm infants.

Original languageEnglish
Pages (from-to)131-139
Number of pages9
JournalPediatric Research
Issue number1
Early online date22 Mar 2021
Publication statusPublished - Jul 2021
MoE publication typeA1 Journal article-refereed


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