Supplementary Material for: How to Monitor the Brain during Immediate Neonatal Transition and Resuscitation: A Systematic Qualitative Review of the Literature

<b><i>Background:</i></b> The brain is vulnerable to injury and dysfunction during transition after birth in neonates. Clinical assessment of the neurological status immediately following birth is difficult, especially during resuscitation. <b><i>Objective:</i></b> Our aim was to review physiological monitoring of the brain during immediate postnatal transition - the first 15 min after birth. <b><i>Methods:</i></b> A systematic search of PubMed and EMBASE was performed using the following terms: newborn, neonate, neonates, transition, after-birth, delivery room, cerebral, brain, monitoring, neurology, oxygenation, saturation, activity, imaging, perfusion, Doppler, and blood flow. Additional articles were identified by manual search of cited references. Only human studies describing cerebral changes during the first 15 min after birth were included. <b><i>Results:</i></b> Six studies were identified, which described sequential measurements of cerebral perfusion using Doppler sonography, one of these in combination with continuous monitoring of cerebral tissue oxygenation with near-infrared spectroscopy (NIRS). A further 15 studies were identified that used NIRS to continuously monitor cerebral tissue oxygenation. In one study, cerebral activity was continuously monitored with an additional amplitude-integrated encephalogram. <b><i>Conclusion:</i></b> Monitoring the brain provides additional information during immediate transition and may help to guide resuscitation. Doppler sonography is technically challenging during resuscitation and is therefore of limited value. NIRS provides continuous monitoring and is feasible even in very-low-birth-weight infants. In the future, an amplitude-integrated encephalogram might give further information on the status of the brain, but before any of these modalities can routinely be recommended during neonatal resuscitation, clinical trials targeting stable brain function parameters are needed.

**背景**：新生儿出生后过渡期内，大脑极易遭受损伤与功能障碍。出生后即刻对神经系统状态开展临床评估难度较大，尤其在复苏过程中。
**研究目标**：本研究旨在综述新生儿出生后即刻过渡期（即出生后首15分钟）的大脑生理监测技术。
**研究方法**：本研究对PubMed与EMBASE数据库进行系统检索，检索关键词包括：新生儿、过渡期、出生后、产房、大脑、监测、神经学、氧合、饱和度、脑活动、成像、灌注、多普勒、血流量。此外通过手工检索参考文献列表补充获取相关文献。最终仅纳入针对出生后首15分钟内大脑变化的人体研究。
**研究结果**：共检索到6项采用多普勒超声（Doppler sonography）序贯测量脑灌注的研究，其中1项同时结合近红外光谱（near-infrared spectroscopy, NIRS）对脑组织氧合进行持续监测。另有15项研究采用NIRS持续监测脑组织氧合水平。另有1项研究通过附加的振幅整合脑电图（amplitude-integrated encephalogram）对脑活动进行持续监测。
**研究结论**：在出生即刻过渡期内，大脑监测可提供额外的临床信息，有助于指导复苏操作。但多普勒超声在复苏过程中存在技术难度，因此应用价值有限。NIRS可实现持续监测，即便针对极低出生体重儿也具备可行性。未来，振幅整合脑电图或可进一步提供大脑状态相关信息，但在将上述监测手段常规应用于新生儿复苏前，仍需开展针对稳定脑功能参数的临床试验。