# Associations between postnatal cerebral oxygen availability and utilization in very to late preterm infants and neurodevelopmental outcome

## TL;DR

This study shows that cerebral oxygen levels in preterm infants are linked to better neurodevelopmental outcomes, with differences observed between males and females.

## Contribution

The study identifies sex-specific associations between cerebral oxygen metrics and neurodevelopment in preterm infants.

## Key findings

- Higher cerebral oxygen availability and utilization are associated with better cognitive and language scores at age 2.
- Associations between oxygen metrics and motor scores are observed only in males.
- Sex-specific differences suggest males may be more vulnerable to cerebral oxygen imbalances.

## Abstract

Preterm children are more likely to experience neurodevelopmental challenges than neonates born at term. Early biomarkers of brain development may help clinicians to identify children in need of early interventions. The main objective of this study was to assess the associations between postnatal cerebral oxygen availability and utilization with neurodevelopmental outcome in preterm infants and explore sex-specific differences. This prospective observational cohort included 227 infants born at 29–36 weeks of gestation who underwent bedside optical neuromonitoring around term-equivalent age to measure cerebral oxygen availability (blood flow and delivery [CDO2i]) and utilization (metabolism [CMRO2i] and extraction fraction [OEF]). Neurodevelopmental outcome was assessed at 2 years corrected age. Linear regression analyses were used to assess the associations between neuromonitoring parameters and neurodevelopmental scores. Increased CDO2i, CMRO2i and OEF were associated with higher cognitive and language scores. When stratifying by sex, most of these associations were stronger in males than females. Associations between neuromonitoring parameters and motor scores were observed only in males. These results support the potential role of bedside optical neuromonitoring to provide early biomarkers of brain health and maturation in preterm infants and suggest sex-specific developmental mechanisms, which may indicate higher vulnerability in males.