To test the hypothesis that near-infrared spectroscopy (NIRS)-determined patterns of regional cerebral oxygen saturation (rScO₂), cerebral fractional tissue oxygen extraction (cFTOE), and autoregulatory ability can identify neonates at risk for developing peri-intraventricular hemorrhage (PIVH).

This case-control study is a subanalysis of 30 neonates who developed PIVH >12 hours after admission as part of a lager prospective observational cohort study comprising 650 preterm neonates born at ≤32 weeks’ gestational age. PIVH was diagnosed by cranial ultrasound, performed at least once daily. Mean arterial blood pressure (MABP), NIRS-determined rScO_2, cFTOE, and MABP–rScO₂ correlation were monitored from birth to 72 hours of age.

Infants with PIVH received more inotropic drugs before being diagnosed with PIVH. Significantly more infants with severe PIVH needed treatment for patent ductus arteriosus. The MABP–rScO₂ correlation was >0.5 significantly more often before mild/moderate PIVH and after severe PIVH compared with controls. rScO₂ was higher and cFTOE lower in infants before severe PIVH.

NIRS-monitored rScO₂ and cFTOE suggest cerebral hyperperfusion in infants with severe PIVH. Moreover, MABP–rScO₂ correlation indicates more blood pressure-passive brain perfusion in infants with PIVH. Continuous assessment of patterns of cerebral oxygenation and arterial blood pressure may identify those preterm infants at risk for severe PIVH and prompt consideration of preventive measures.