Cerebral oxygenation during umbilical arterial blood sampling in very low birth weight neonates.

OBJECTIVE

Umbilical arterial blood sampling (UABS) has been associated with cerebral oxygen saturation (CrSO2) decrements in very low birth weight (VLBW) neonates. We sought to determine patient- and UABS procedure-related factors contributing to this effect.

STUDY

DESIGN

In this prospective cohort study, cerebral near-infrared spectroscopy was performed during UABS procedures in VLBW neonates. Analyses were conducted to determine subject- and procedure-related factors correlating with CrSO2 decrements.

RESULT: Thirty subjects (mean (±SD) 27 ± 2 week GA and 1058 ± 279 g BW) underwent 84 UABS procedures between 5 and 183 postnatal hours. Six (20%) experienced CrSO2 decrements, less than previously reported. Subjects with CrSO2 decrements had earlier GA and lower BW, though these were not statistically significant differences. CrSO2 decrements occurred with lower pre- and post-UABS pulse oximetry (p = 0.004; p < 0.001), lower arterial oxygen partial pressure (p < 0.001), lower baseline CrSO2 (p = 0.01), and faster "priming" blood reinfusion (p = 0.03) and saline flush (p = 0.02).

CONCLUSION

UABS procedures appear to be associated with CrSO2 decrements more commonly among VLBW neonates already experiencing disturbances in cerebral oxygen delivery-consumption balance. Shorter durations of UABS procedural components may contribute to CrSO2 decrements.