The purpose of this study is to characterize the normal brain function of premature infants (23 to 31+6 weeks GA) during birth transition and through the first 72 hours of life.
The investigators will measure components of brain function using two sophisticated, non-invasive technologies. First, amplitude integrated electroencephalography (EEG), a "simplified" EEG with four sensors (single channel), enables continuous non-invasive monitoring of cerebral activity. Second, near-infrared spectroscopy (NIRS) is another non-invasive technology that allows continuous real-time measurement of regional tissue oxygen utilization of the brain. Both technologies have been used in newborns and have been predictive of brain injury or neurodevelopmental impairment.
Study Type
OBSERVATIONAL
Enrollment
130
Sharp Mary Birch Hospital for Women and Newborns
San Diego, California, United States
EEG
amplitude integrated EEG to measure brain activity
Time frame: Birth to 72 hours of life
NIRS
Cerebral tissue oxygen saturation (StO2), Near-infrared spectroscopy to measure brain perfusion
Time frame: Birth to 72 hours of life
Apgar scores
1 and 5 minute Apgar scores
Time frame: 1, 5 and 10 minutes of life if applicable
Cord gases
Arterial or venous pH (acid/base), base deficit
Time frame: Upon delivery
Resuscitation intervention
Fraction of inspired oxygen (FiO2), cpap, positive pressure ventilation (PPV), intubations.
Time frame: From birth to 10 minutes of life
Maximum FiO2
Maximum FiO2 during resuscitation at birth
Time frame: From birth to 10 minutes of life
Maximum peak inspiratory pressure
Peak inspiratory pressure of respiratory support
Time frame: From birth to 10 minutes of life
Heart rate
Time frame: Birth to 72 hours of life
Heart rate by EKG during resuscitation (substudy)
A substudy of 40 infants will have EKG leads placed on newborns during resuscitation; 20 will have the display blinded, and 20 will have values available to the team. The amount of resuscitation (mean airway pressure FiO2 will be compared between groups).
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Time frame: Birth
Cardiac output
Time frame: From neonatal intensive care unit (NICU) admission through 72 hours of life
Mean arterial blood pressure
Time frame: From NICU admission through 72 hours of life
Use of cardiac inotropes
Dopamine, dobutamine, epinephrine
Time frame: From birth through discharge to home, up to 9 months of age
Head Ultrasound
Cranial ultrasonography
Time frame: Within 24 hours of life and at approximately 72 hours of life
MRI
Presence of brain injury (e.g. intraventricular hemorrhage (IVH), (PVL)
Time frame: From birth through discharge to home, up to 9 months of age
Neurodevelopmental impairment at 2 year follow up
Neurodevelopmental assessment at 2 year corrected gestational age
Time frame: 18 to 30 months corrected gestational age