Neonatal Med.  2019 Aug;26(3):121-127. 10.5385/nm.2019.26.3.121.

Clinical Application of Near-Infrared Spectroscopy in Neonates

• Jeon GW

• KMID: 2457179
• DOI: http://doi.org/10.5385/nm.2019.26.3.121

Abstract

The incidence of cerebral palsy has not decreased despite advances in neonatal care. Preterm infants are at a high risk of cerebral palsy. Moreover, preterm infants might experience permanent neurological sequelae due to injury in the preterm brain. Although the etiology of preterm brain injury is not fully understood, preterm brain injury is strongly associated with abnormal cerebral perfusion and oxygenation. Monitoring systemic blood pressure or arterial oxygen saturation using pulse oximetry is not enough to guarantee proper cerebral perfusion or oxygenation. Early detection of improper cerebral perfusion can prevent irreversible cerebral damage. To decrease brain injury through the early detection of under-perfusion and deoxygenation, other diagnostic modalities are needed. Near-infrared spectroscopy can continuously and noninvasively monitor regional oxygen saturation (rSOâ‚‚), which reflects the perfusion and oxygenation status of tissues at bedside. Near-infrared spectroscopy represents a balance between tissue oxygen supply and demand. Cerebral rSOâ‚‚ monitoring has been used most frequently in neonatal cardiac surgery to monitor cerebral oxygenation and prevent hypoxic damage or shock. Recently, cerebral, renal, or splanchnic rSOâ‚‚ in neonates is frequently monitored. The progression of a disease, brain injury, and death can be prevented by detecting changes in rSOâ‚‚ values using near-infrared spectroscopy. In this article, the basic principles, usefulness, and applications of near-infrared spectroscopy in neonates are discussed.

Keyword

Cerebrovascular circulation; Spectroscopy, near-infrared; Infant, newborn; Infant, premature; Splanchnic circulation

MeSH Terms

Blood Pressure
Brain
Brain Injuries
Cerebral Palsy
Cerebrovascular Circulation
Humans
Incidence
Infant, Newborn*
Infant, Premature
Oximetry
Oxygen
Perfusion
Shock
Spectroscopy, Near-Infrared*
Splanchnic Circulation
Thoracic Surgery
Oxygen

Figure

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  Figure 1. Principles of near-infrared spectroscopy. The nearinfrared spectroscopy device emits light from a light emitting diode. These emitted photons can pass through tissues and become absorbed by oxygenated and deoxygenated hemoglobin in living tissues at different ratios according to the oxygenation status of tissues. These photons from the light source can make arc. The non-absorbed fraction of the photons is received by two detectors. The proximal arc detector receives signal from the superficial tissue whereas the distal arc detector receives signal from both the superficial and deep tissues. The proximal value is subtracted from the distal value and the result represents the oxygen saturation (rSO2) at a depth of 1 to 2 cm in the deep tissue.

• 

  Figure 2. Cerebral regional oxygen saturation (crSO2) and cerebral fractional tissue oxygen extraction (cFTOE) immediately after birth. (A) The 10th, 25th, 50th, 75th, and 90th percentiles of crSO2 during the first 15 minutes after birth in neonates who do not require medical support. The crSO2 is low at birth. It increases for several minutes and becomes stable. (B) The 10th, 25th, 50th, 75th, and 90th percentiles of cFTOE during the first 15 minutes after birth in neonates who do not require medical support. The cFTOE is high at birth. It decreases for several minutes and becomes stable. Adapted from Pichler et al.21), with permission from Elsevier.

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