Has the time come to use near-infrared spectroscopy as a routine clinical tool in preterm infants undergoing intensive care?
Open Access
- 28 November 2011
- journal article
- review article
- Published by The Royal Society in Philosophical Transactions of the Royal Society A: Mathematical, Physical and Engineering Sciences
- Vol. 369 (1955), 4440-4451
- https://doi.org/10.1098/rsta.2011.0261
Abstract
Several instruments implementing spatially resolved near-infrared spectroscopy (NIRS) to monitor tissue oxygenation are now approved for clinical use. The neonatal brain is readily assessible by NIRS and neurodevelopmental impairment is common in children who were in need of intensive care during the neonatal period. It is likely that an important part of the burden of this handicap is due to brain injury induced by hypoxia–ischaemia during intensive care. In particular, this is true for infants born extremely preterm. Thus, monitoring of cerebral oxygenation has considerable potential benefit in this group. The benefit, however, should be weighed against the disturbance to the infant, against the limitations imposed on clinical care and against costs. The ultimate way of demonstrating the ‘added value’ is by a randomized controlled trial. Cerebral oximetry must reduce the risk of a clinically relevant endpoint, such as death or neurodevelopmental handicap. We estimate that such a trial should recruit about 4000 infants to have the power to detect a reduction in brain injury by one-fifth. This illustrates the formidable task of providing first-grade evidence for the clinical value of diagnostic methods. Is it a window of opportunity for the establishment of a rational basis before another technology is added to an already overly complex newborn intensive care?This publication has 29 references indexed in Scilit:
- Cerebral Oxygen Saturation-Time Threshold for Hypoxic-Ischemic Injury in PigletsAnesthesia & Analgesia, 2009
- Randomized Trial of Milrinone Versus Placebo for Prevention of Low Systemic Blood Flow in Very Preterm InfantsThe Journal of Pediatrics, 2009
- Cerebral Oxygen Desaturation Predicts Cognitive Decline and Longer Hospital Stay After Cardiac SurgeryThe Annals of Thoracic Surgery, 2009
- Brain injury in premature infants: a complex amalgam of destructive and developmental disturbancesThe Lancet Neurology, 2009
- Research on the relationship between brain anoxia at different regional oxygen saturations and brain damage using near-infrared spectroscopyPhysiological Measurement, 2007
- Autoregulation of Cerebral Blood FlowNeoReviews, 2006
- Low superior vena cava flow and neurodevelopment at 3 years in very preterm infantsThe Journal of Pediatrics, 2004
- Optimizing Intraoperative Cerebral Oxygen Delivery Using Noninvasive Cerebral Oximetry Decreases the Incidence of Stroke for Cardiac Surgical PatientsThe Heart Surgery Forum, 2004
- Heterogeneity of cerebral vasoreactivity in preterm infants supported by mechanical ventilationThe Journal of Pediatrics, 1989
- Cerebral Blood Flow, PaCO2 Changes, and Visual Evoked Potentials in Mechanically Ventilated, Preterm InfantsActa Paediatrica, 1987