Cerebral oxygenation during the first 15 minutes after birth and short-term outcome measured by the Motor Optimality Score – Revised (MOS-R) in preterm infants

BACKGROUND: Monitoring cerebral regional oxygen saturation (crSO₂) using near-infrared spectroscopy (NIRS) during immediate postnatal transition may help detect and mitigate cerebral hypoxia. General Movement Assessment (GMA), including fidgety movements (FMs) and the Motor Optimality Score-Revised (MOS-R), is widely used to evaluate early motor development. OBJECTIVE: To assess differences in early motor outcome at 6-20 weeks corrected age ac-cording to group allocation in the randomized multicenter COSGOD III trial. DESIGN: Retrospective ancillary observational study. PATIENTS AND SETTING: Preterm infants (<32 weeks' gestation) enrolled in COSGOD III at two Austrian centers (Graz and Innsbruck) with available GMA video recordings at 6-20 weeks corrected age were included. MOS-R was scored retrospectively from these recordings. INTERVENTION: In COSGOD III, infants randomized to the NIRS group received continuous crSO₂ monitoring during immediate postnatal transition to guide resuscitation; in the control group, crSO₂ values were not displayed. MAIN OUTCOME MEASURES: MOS-R (range 5-28) derived from GMA video analysis. RESULTS: A total of 162 infants were included (NIRS: n=76; control: n=86; median gestational age 29.6 vs. 28.8 weeks; p=0.357). Normal FMs were present in 95% of infants (96% vs. 94%). However, MOS-R scores were significantly higher in the NIRS group (median [IQR]: 26 [24-28] vs. 24 [22-26]; p=0.003), with more infants showing an age-adequate motor repertoire (83% vs. 66%; p=0.003). CONCLUSION: Although FM presence was similar between groups, NIRS-guided management during immediate transition was associated with improved early motor performance, sug-gesting that targeted cerebral oxygenation may influence early neurodevelopment.