Two-year neurodevelopmental outcome in preterm neonates with cerebral oxygenation monitoring after birth: a multinational, multicenter retrospective follow-up study of the COSGOD III trial.

Introduction: During immediate neonatal transition, cerebral tissue oxygen saturation (crSO Aim: To assess mortality and long-term neurodevelopmental outcomes at 2 years of age in preterm neonates who underwent cerebral oxygen saturation monitoring and received targeted interventions during the immediate postnatal transition. Methods: This 2-year follow-up observational study included preterm neonates born before 32 weeks of gestation and originally enrolled in the multicenter, multinational COSGOD III randomized controlled trial across 10 European centers. Neonates who underwent routine neurodevelopmental assessments at 18-30 months of corrected age or had available outcome data from medical records were included. Analyses were conducted according to the COSGOD III group allocations [near-infrared spectroscopy (NIRS) group vs. control group]. Subgroup analyses were performed for very preterm (28 + 0 to 31 + 6 weeks) and extremely preterm (<28 + 0 weeks) neonates. The primary outcome was survival without moderate-to-severe neurodevelopmental disability (NDD), defined by cognitive or language impairment, cerebral palsy, visual, or hearing impairment. Results: Of the 526 eligible neonates, 417 were analyzed. Survival without moderate-to-severe NDD was similar between the groups: 129 (61.1%) in the NIRS group and 128 (62.1%) in the control group [(relative risk) (95% CI): 0.98 (0.86-1.21), Conclusions: Cerebral oxygen saturation monitoring with targeted interventions during immediate postnatal care did not improve overall survival without NDD but may reduce specific impairments in very preterm infants (28 + 0 to 31 + 6 weeks).