Background Perinatal asphyxia remains a challenging entity. NIRS offers a method to continuously monitor cerebral oxygen saturation.
Aim To obtain insight into haemodynamic changes during hypothermia and rewarming in perinatal asphyxia using NIRS.
Methods We report of an asphyxiated patient (37+6 weeks’, Apgar 6 and 8 at 1 and 5 minutes, first arterial blood gas pH of 6.67, base deficit –25). NIRS was started during the first hour of life and continued for a total recording time of 125 hours. Simultaneously, we measured brain function using amplitude-integrated electroencephalography (aEEG). On day 7 magnetic resonance imaging (MRI) has been performed. After discharge, the patient was reassessed neurologically.
Results The initial cerebral rSO2 was 65%. When cooling was started FTOE was 0.28. At 33.5°C FTOE had decreased to 0.20, cerebral rSO2 increased to 70%. After rewarming cerebral rSO2 was 85%, and FTOE 0.11. Initially, aEEG showed a mixed burst-suppression and discontinuous pattern which improved to a discontinuous pattern only during the first 12 hours. After rewarming aEEG normalized and showed developing sleep-wake cycles. MRI did not show any signs of hypoxic damage. After discharge the patient presented neurodevelopmentally normal.
Conclusion After having cooled down the patient, both NIRS and aEEG showed an improvement (increase of rSO2, decrease of FTOE, loss of burst-supression in aEEG). aEEG displays cerebral function, cerebral NIRS expands information to cerebral oxygen supply and extraction. MRI and neurodevelopmental assessment proved the observed aEEG and NIRS data.