Association between cerebral oxygen saturation and neurological injury in asphyxiated neonates in a middle-income country: a retrospective cohort study

Background Neonatal outcomes following perinatal asphyxia vary significantly between low- and middle-income countries (LMICs) and high-income settings. Near-infrared spectroscopy is a non-invasive method for monitoring regional cerebral oxygen saturation (rScO2), providing real-time insights into brain oxygenation. In LMICs, where healthcare resources are limited, early rScO2 monitoring during therapeutic hypothermia (TH) may support neurological risk stratification. This study aimed to evaluate the association between early rScO2 levels and brain MRI abnormalities in asphyxiated neonates during their first week of life. Methods A retrospective longitudinal study was conducted on term neonates with moderate-to-severe perinatal asphyxia undergoing TH at a high-complexity healthcare institution in an LMIC. Continuous rScO2 monitoring was performed for 72 hours during cooling and rewarming. Values were analysed at 6-hour intervals. The primary outcome was abnormal brain MRI findings during the first week, defined as radiological injury to the basal ganglia, thalami, cortical/watershed areas, white matter or vascular territories. Logistic regression was used to assess the association between rScO2 and MRI abnormalities, and receiver operating characteristic analysis was used to evaluate predictive performance. Results 88 neonates were included, of which 29 had abnormal MRI findings. All patients were referred from lower-complexity centres. Elevated rScO2 in the first 6 hours was significantly associated with abnormal MRI findings (adjusted OR, 1.10; 95% CI 1.02 to 1.18). The rScO2 threshold showed limited sensitivity and moderate specificity. Conclusions Higher rScO2 values during the first 6 hours of TH were associated with abnormal brain MRI findings. Although not definitive, early rScO2 monitoring may aid in identifying neonates at risk of neurological injury in LMICs.