Impact of cerebral oxygenation-guided resuscitation during immediate postnatal transition on brain injury and brain growth detected by MRI in very preterm neonates: a secondary outcome analysis of the multicenter randomized phase 3 clinical COSGOD II

The prospective, randomized-controlled multicenter COSGOD III trial was designed to investigate whether interventions guided by cerebral oxygen saturation (crSO2) measured with near-infrared spectroscopy (NIRS group) during the immediate postnatal transition increase survival without cerebral injury of very preterm infants compared with standard care alone (control group). The aim of this secondary outcome study was to compare brain injury and brain growth between the two groups, as assessed by magnetic resonance imaging (MRI) at near-term age. Patients from five centers participating in the COSGOD III trial, which performed near-term MRI, were evaluated for the presence of brain injury (intraventricular hemorrhage, cerebellar hemorrhage, white matter injury) and brain growth (transcerebellar/biparietal diameter, interhemispheric distance). This study included 172 infants (86 per group) with a median gestational age of 28.4 weeks and a median birth weight of 1045 grams. The incidence of brain injury did not differ between the groups. Infants in the NIRS group exhibited a significantly larger median biparietal diameter (median [IQR] 78.6 [76.3–82.1] mm) compared to the control group (76.7 [74.7–80.0] mm). A trend toward a lower rate of abnormal biparietal diameter was observed in the NIRS group. Monitoring of crSO2 with dedicated treatment guidelines during the immediate postnatal transition had no effect on the incidence of brain injury assessed by MRI. The significantly larger biparietal diameter in the NIRS group may be indicative of enhanced brain development. The relationship between this structural advance in the NIRS group and long-term functional outcomes requires further investigation.