Background: Oxygen delivery to the brain is dependent on cardiac output and arterial oxygen content. Objectives: The study was designed to investigate the influence of a left-to-right shunt via the ductus arteriosus (DA) on regional oxygen saturation (rSO₂) of the brain and peripheral tissue during postnatal transition. Methods: Nested case-control study. In term neonates after elective cesarian section, rSO₂ of the brain and pre- and postductal peripheral tissue were measured 15 min after uncomplicated postnatal transition. Two groups were formed according to shunt flow characteristics via the DA: shunt group (with a left-to-right shunt), and nonshunt group (no shunt). Results: Of 80 infants, in 58 (72%) a left-to-right shunt was identified, and in 22 (28%) no flow was seen via the DA. The 22 infants formed the nonshunt group. They were matched with 22 newborn infants with a left-to-right shunt via the DA (shunt group). Infants in the nonshunt group had significantly lower cerebral rSO₂ values and higher fractional tissue oxygen extraction and heart rate values. There were no significant differences in regard to peripheral rSO₂ values. Conclusion: During postnatal transition, term infants with a left-to-right shunt via the DA have significantly higher cerebral rSO₂ values compared to infants without shunt flow.

In a mixed cohort of neonates, crSO2 measurements were identical when using the INVOS 5100 neonatal sensor and the pediatric sensor. We conclude that studies using the INVOS 5100 neonatal or pediatric sensor are well comparable.

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Objective: To determine the risk for the development of periventricular leukomalacia (PVL) of twins and triplets compared to singletons. Methods:Retrospective single-centre study including all infants ≤ 35 weeks of gestational age with cystic PVL documented by ultrasound scans between 1988 and 2008.Results: Of 4926 singleton births, 579 twins, 37 triplets, and one quintuplet (excluded from further analysis) 117 singletons and 39 multiples were diagnosed as having cystic PVL. Perinatal data did not differ between groups as did not ultrasonographic findings and neurodevelopmental outcome (cerebral palsy rate 81 vs. 77%). The relative risk (RR) for twin pregnancy resulting in preterm birth and having at least one infant with PVL was 2.181 (CI 95% 1.474 -3.228, p< .0001), and for triplet pregnancy 6.793 (CI 95% 2.470 -13.108, p< .0001). The RR increased by 2.608 (1.075 -6.329, p=.017) from twin to triplet pregnancy. Multiples had a higher rate of caesarean section (73 vs. 44%, p< .001), less often preterm premature rupture of the membranes (33 vs. 58%, p< .006) and clinical chorioamnionitis (28 vs. 46%, p=.039), and fewer diagnoses of fetal distress (18 vs. 34%, p< .001), hyperbilirubinemia (23 vs. 53%, p< .001) and intraventricular hemorrhage grade 2 (0 vs. 9%, p=.024).Conclusions: Our findings demonstrate an increased risk for the development of PVL in twin and triplet pregnancy. No overt risk factors were found in multiples compared to singletons.

Background and aim: In many neonates the ductus arteriosus (DA) remains open after transition after birth. Aim of the present study was to evaluate the influence of an open DA on cerebral and peripheral regional tissue oxygen saturation 15 minutes after birth.