Perioperative use of cerebral and renal near-infrared spectroscopy in neonates: a 24-h observational study.

Koch, Henrik W; Hansen, Tom G

BACKGROUND Neonates undergoing surgery and intensive care still carry a significant morbidity and mortality often related to hypoxic/ischemic events; some of which may go undetected by conventional monitoring. Near-infrared spectroscopy (NIRS) is a noninvasive, continuous method of measuring regional tissue oxygen saturation, and may be used to supplement conventional monitoring to improve neonatal perioperative care. However, high costs and lack of evidence regarding improved outcomes have minimized wider perinatal use of NIRS. The aim of this study was to investigate the applicability of NIRS in neonates and premature infants undergoing noncardiac surgeries. METHOD Neonates were monitored with both cerebral and renal NIRS for 24 h after induction of anesthesia and compared with systemic blood pressure (BP), peripheral oxygen saturation (SpO2 ), and heart rate (HR). RESULTS A total of 23 368 min of data were collected from 21 neonates. NIRS reported cerebral/renal hypoxia 2.8 (±8.3)%/19.3 (±25.4)% of the time intraoperatively and 9.6 (±17.0)%/9.9 (±18.9)% of the time postoperatively. A moderate positive correlation was found between SpO2 and NIRS (φcerebral = 0.371, φrenal = 0.542). BP showed a weaker positive correlation (φcerebral = 0.231, φrenal = 0.246), and HR no correlation (φcerebral = -0.083, φrenal = -0.029). NIRS reported hypoxia two to three times more frequently than SpO2 , and SpO2 readings were 10-15 s delayed compared to NIRS. Furthermore, NIRS appeared effective at detecting postoperative apnea. CONCLUSION Near-infrared spectroscopy is an easily applicable technique that appears effective at detecting hypoxic events and postoperative apneas in neonates. The high incidences of regional hypoxia reported by NIRS in this study imply that there is a need for a more specific regional cerebral and renal monitoring. Despite some practical and economical limitations, NIRS may be considered a useful supplement to perinatal perioperative intensive care.