Impact of bradycardia on cerebral oxygenation and cerebral blood volume during apnoea in preterm infants.

Apnoea in prematurity is a common problem in neonatology; and it is the impaired oxygen delivery during apnoea, which can harm the brain. The aim of this study was to evaluate the effect of bradycardia (below 80 beats min(-1)) on 'cerebral haemoglobin oxygenation index' (cHbD) and cerebral blood volume (CBV) during apnoea in stable preterm infants measured by means of near infrared spectroscopy. Twenty-six episodes of mixed and central apnoea with bradycardia (bradycardia group) in 20 preterm infants were compared to 26 episodes of mixed and central apnoea without bradycardia (non-bradycardia group) in 19 preterm infants. cHbD decreased significantly more in the bradycardia group (-11.33 micromol 1(-1) after 30 s) than in the non-bradycardia group (-6.36 micromol 1(-1) after 30 s) (p < 0.05). CBV decreased significantly in the bradycardia group (p < 0.05), whereas CBV did not change significantly in the non-bradycardia group. Peripheral oxygen saturation (SaO2) decreased similarly in both groups. The aggravation of decrease of cHbD and the decrease of CBV during bradycardia in association with apnoea could be explained by decrease in cerebral blood flow, which caused decrease in cerebral oxygen delivery. This decrease of oxygen delivery during bradycardia might worsen long-term neurodevelopmental outcome in preterm infants with apnoea.