Saving the smallest when the lungs need support

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 (Image: Pixabay CC0)
(Image: Pixabay CC0)

When a child is born before the completed 37th week of pregnancy, it is called a premature birth. Modern medicine makes it possible to care for premature babies, but depending on the baby’s stage of development, some of them face major challenges. One of the biggest problems is the (un)maturity of the lungs, and thus the oxygen supply to children who are born prematurely. Researchers at Med Uni Graz have made great progress in this area as part of a multi-center study.

Oxygen as a medicine

All premature babies show a certain degree of lung immaturity immediately after birth - the earlier the birth, the more immature the lungs. Therefore, the majority of all premature infants require respiratory support and supplemental oxygen as part of their initial care. Oxygen is a very potent drug that ensures survival in many situations. But of course it also has side effects. Many studies have shown that premature infants in particular can be very sensitive to both over- and underdoses of oxygen. To determine the dose, pulse oximetry is used, which continuously measures the oxygen saturation in the blood, usually at the hand or foot. However, the brain is the organ where sufficient oxygen supply is considered extremely important, especially in premature infants - particularly to enable good neurological development," explains Berndt Urlesberger, Clinical Department of Neonatology at Med Uni Graz.

The two research units ,,Micro- and Macrocirculation of the Newborn" (Head: Gerhard Pichler) and ,,Cerebral Development and Oxymetry" (Head: Berndt Urlesberger) of the Clinical Department of Neonatology of the Medical University of Graz have developed in close cooperation the idea that it could be advantageous to use in addition to pulse oxymetry also the oxygen saturation of the brain tissue to control the respiratory support and administration of oxygen in the context of initial care after birth.

International cooperation

Regional oxygen saturation is measured using near-infrared spectroscopy (NIRS), a non-invasive, painless, continuous measurement methodology. A sensor is placed on the forehead and the absorption behavior of light waves is used to measure the regional oxygen saturation of brain tissue. Over the past 14 years, numerous preliminary studies in Graz have not only determined standard values for cerebral oxygen saturation, but also investigated the physiological relationships and influencing factors. With this knowledge, a concept was developed that includes a combination of clinical instructions for action and the monitoring of cerebral oxygen saturation," says Berndt Urlesberger, explaining the history of research in this area at Med Uni Graz. The study concept was developed at the Clinical Department of Neonatology in Graz as well as the management of the study, which was eventually conducted in several countries in Europe and North America. Gerhard Pichler from Graz was in charge of the study.

The results of this large international multi-center study have now been published in the high-ranking British Medical Journal. This is the world’s first clinical study on this topic. A total of 607 preterm infants with less than 32 weeks of gestation were included in this study. It was shown that this new approach has the potential to reduce mortality and brain damage in preterm infants.