Neonatal NIRS monitoring: recommendations for data capture and review of analytics

Abstract

Brain injury is one of the most consequential problems facing neonates, with many preterm and term infants at risk for cerebral hypoxia and ischemia. To develop effective neuroprotective strategies, the mechanistic basis for brain injury must be understood. The fragile state of neonates presents unique research challenges; invasive measures of cerebral blood flow and oxygenation assessment exceed tolerable risk profiles. Near-infrared spectroscopy (NIRS) can safely and non-invasively estimate cerebral oxygenation, a correlate of cerebral perfusion, offering insight into brain injury-related mechanisms. Unfortunately, lack of standardization in device application, recording methods, and error/artifact correction have left the field fractured. In this article, we provide a framework for neonatal NIRS research. Our goal is to provide a rational basis for NIRS data capture and processing that may result in better comparability between studies. It is also intended to serve as a primer for new NIRS researchers and assist with investigation initiation.

Cerebral Blood Flow Monitoring in High-Risk Fetal and Neonatal Populations

“…Initial results in the SafeBoosC II randomized controlled trial of NIRS in neonates born extremely preterm did not show an impact on EEG outcomes ( 121 ) or neurodevelopmental outcome at age 2 years ( 119 ), but an additional Phase III randomized-controlled trial is underway ( 122 ). A practical guide to the use of NIRS in neonates was recently published by Vesoulis et al and the authors conclude that there is a need for large studies of comparative approaches ( 123 ), which the SafeBoosC III trial will be a strong contributor. These studies must occur while equipoise still exists.…”

Supplemental Oxygen in the Newborn: Historical Perspective and Current Trends

“…Specific guidelines for the use and interpretation of NIRS may provide a framework to apply this technology to specific clinical scenarios to optimize oxygen delivery in the NICU [ 119 ]. The simplicity of pulse oximetry makes it an ideal monitor to guide clinical therapy, and the refinement of oxygen therapy guidelines using pulse oximetry has clearly shown benefit.…”

Neuroprotection of the Perinatal Brain by Early Information of Cerebral Oxygenation and Perfusion Patterns

“…Once this step is performed, there are two main approaches possible: analysis in the time domain or in the frequency domain. Time domain analysis calculates the correlation between the BP and rScO 2 over short continuous segments, which can then be averages and distributed according to the corresponding BP values, thus having one correlation value per "bin" of blood pressure value [80,[82][83][84]. Frequency domain analysis also explores the relation between these two signals, but with a focus on specific frequency bands [39].…”