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Neonatal somatic oxygenation and perfusion assessment using near-infrared spectroscopy

Part of the series on near-infrared spectroscopy by the European Society of Paediatric Research Special Interest Group “Near-Infrared Spectroscopy”

Pediatric Research (2024)Cite this article

Abstract

In this narrative review, we summarize the current knowledge and applications of somatic near-infrared spectroscopy (NIRS), with a focus on intestinal, renal, limb, and multi-site applications in neonates. Assessing somatic oxygenation at various body locations in neonates may aid in the understanding of underlying pathophysiology of organ injury. Considering cerebral autoregulation may be active to protect the brain during systemic circulatory failure, peripheral somatic oxygenation may potentially provide an early indication of neonatal cardiovascular failure and ultimate hypoxemic injury to vital organs including the brain. Certain intestinal oxygenation patterns appear to be associated with the onset and course of necrotizing enterocolitis, whereas impaired renal oxygenation may indicate the onset of acute kidney injury after various types of hypoxic events. Peripheral muscle oxygenation measured at a limb may be particularly effective in the early prediction of shock in neonates. Using multi-site NIRS may complement current approaches and clinical investigations to alert for neonatal tissue hypoxemia, and potentially even guide management. However, somatic NIRS has its inherent limitations in regard to accuracy. Interpretation of organ-specific values can also be challenging. Last, currently there are limited prospective intervention studies, and clinical benefits need to be examined further, after the clarification of critical threshold-values.

Impact

  • The assessment of somatic oxygenation using NIRS may contribute to the prediction of specific diseases in hemodynamically challenged neonates. Furthermore, it may give early warning signs for impending cardiovascular failure, and impaired cerebral circulation and oxygenation.

  • We present a comprehensive overview of the literature on applications of NIRS to various somatic areas, with a focus on its potential clinical applicability, including future research directions.

  • This paper will enable prospective standardized studies, and multicenter collaboration to obtain statistical power, likely to advance the field.

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Fig. 1: NIRS sensor positions in the neonate.

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Funding

Funding

Financial support of publication costs by the European Society for Pediatric Research (ESPR) is gratefully acknowledged.

Author information

Authors and Affiliations

  1. Division of Neonatology, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Elisabeth M. W. Kooi & Elisabeth Kooi

  2. Division of Newborn Medicine, Department of Pediatrics, Mountainside Medical Center, Montclair, NJ, USA

    Jonathan P. Mintzer & Jonathan Mintzer

  3. Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA

    Christopher J. Rhee

  4. Gazi University Hospital, Ankara, Turkey

    Ebru Ergenekon

  5. Department of Neonatology, Tübingen University Hospital, Tübingen, Germany

    Christoph E. Schwarz

  6. Department of Neonatology, Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany

    Christoph E. Schwarz & Christoph Schwarz

  7. Department of Pediatrics, Medical University of Graz, Graz, Austria

    Gerhard Pichler

  8. Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children’s Hospital, Nijmegen, The Netherlands

    Willem P. de Boode, Willem P. de Boode & Kian D. Liem

  9. Neonatal Brain Group, Institut de Recerca Sant Joan de Déu, Barcelona, Spain

    Ana Alarcón

  10. Department of Neonatology, Hospital Sant Joan de Déu, BCNatal (Barcelona Center for Maternal Fetal and Neonatal Medicine), Barcelona, Spain

    Ana Alarcón

  11. Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain

    Ana Alarcón

  12. Department of Neonatology, Wilhelmina Children’s Hospital University Medical Center, Utrecht, The Netherlands

    Thomas Alderliesten & Petra Lemmers

  13. Neonatal Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

    Topun Austin

  14. Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

    Morten Breindahl

  15. Department of Paediatrics and Child Health, INFANT Centre, University College Cork, Cork, Ireland

    Eugene Dempsey & Christoph Schwarz

  16. Division of Newborn Medicine, Department of Pediatrics, Gazi University Hospital, Ankara, Turkey

    Ebru Ergenekon

  17. Department of Neonatology, Copenhagen University Hospital & Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Gorm Greisen

  18. Department of Pediatric Neurology, Gazi University Hospital, Ankara, Turkey

    Kivilcim Gucuyener

  19. Research Unit for Neonatal Micro- and Macrocirculation, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria

    Marlies Krainer

  20. Boston Children’s Hospital, Harvard Medical School, Harvard University, Boston, MA, USA

    Philip Levy

  21. Department of Neonatology, Copenhagen University Hospital, Copenhagen, Denmark

    Mathias Lühr Hansen

  22. Neonatal Intensive Care Unit, S. Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

    Silvia Martini

  23. Department of Neonatology, University College London, London, UK

    Subhabrata Mitra

  24. Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children’s Hospital Tübingen, Tübingen, Germany

    Felix Neunhoeffer

  25. Department of Neonatology, La Paz University Hospital, Madrid, Spain

    Adelina Pellicer

  26. Baylor College of Medicine, Texas Children’s Hospital, Section of Neonatology, Houston, TX, USA

    Christopher Rhee

  27. Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK

    Charles Roehr

  28. National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Medical Sciences, Division, University of Oxford, Oxford, UK

    Charles Roehr

  29. Department of Neonatology, Pediatric Intensive Care, Sleep Medicine, Vest Children’s Hospital Datteln, University Witten-Herdecke, Datteln, Germany

    Claudia Roll

  30. Department of Neonatology, University Children’s Hospital Tübingen, Tübingen, Germany

    Christoph Schwarz

  31. Neonatal Intensive Care Unit, Great Ormond Street Hospital for Children, London, UK

    Cristine Sortica da Costa

  32. Department of Neonatology, Biophysical Monitoring and Cardiopulmonary Therapies Research Unit, Poznan University of Medical Sciences, Poznan, Poland

    Tomasz Szczapa

  33. Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria

    Berndt Urlesberger

  34. Biomedical Optics Research Laboratory, Department of Neonatology, University Hospital Zurich, Zurich, Switzerland

    Martin Wolf

  35. Monash Newborn, Monash Children’s Hospital, Clayton, VIC, Australia

    Flora Wong

  36. Hudson Institute of Medical Research, Department of Paediatrics, Monash University, Melbourne, VIC, Australia

    Flora Wong

Authors
  1. Elisabeth M. W. Kooi
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  2. Jonathan P. Mintzer
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  3. Christopher J. Rhee
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  4. Ebru Ergenekon
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  5. Christoph E. Schwarz
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  6. Gerhard Pichler
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  7. Willem P. de Boode
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Consortia

the ESPR Special Interest Group “Near-Infrared Spectroscopy (NIRS)”

  • Ana Alarcón
  • , Thomas Alderliesten
  • , Topun Austin
  • , Morten Breindahl
  • , Willem P. de Boode
  • , Eugene Dempsey
  • , Ebru Ergenekon
  • , Gorm Greisen
  • , Kivilcim Gucuyener
  • , Elisabeth Kooi
  • , Marlies Krainer
  • , Petra Lemmers
  • , Philip Levy
  • , Kian D. Liem
  • , Mathias Lühr Hansen
  • , Silvia Martini
  • , Jonathan Mintzer
  • , Subhabrata Mitra
  • , Felix Neunhoeffer
  • , Adelina Pellicer
  • , Gerhard Pichler
  • , Christopher Rhee
  • , Charles Roehr
  • , Claudia Roll
  • , Christoph Schwarz
  • , Cristine Sortica da Costa
  • , Tomasz Szczapa
  • , Berndt Urlesberger
  • , Martin Wolf
  •  & Flora Wong

Contributions

Each author has contributed to this work. E.M.W.K., J.P.M., C.J.R., E.E., C.E.S., and G.P. each drafted parts of the article and revised the manuscript critically for important intellectual content. All authors revised the manuscript critically for important intellectual content and gave final approval of the version to be published. All members of the European Special Interest Group “Near-InfraRed Spectroscopy” who actively participated in the creation of this manuscript are listed in the appendix. All these members have substantially contributed to the conception and revision of the manuscript and approved the final version to be published.

Corresponding author

Correspondence to Elisabeth M. W. Kooi.

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Kooi, E.M.W., Mintzer, J.P., Rhee, C.J. et al. Neonatal somatic oxygenation and perfusion assessment using near-infrared spectroscopy. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03226-z

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  • DOI: https://doi.org/10.1038/s41390-024-03226-z

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