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Current state of renal NIRS monitoring in the NICU: results from a CHNC Survey

Journal of Perinatology volume 43, pages 1047–1049 (2023)Cite this article

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Near infrared spectroscopy (NIRS) monitoring of regional tissue oxygenation is becoming more common in neonates and specifically in the Neonatal Intensive Care Unit (NICU) [1]. Advantages of this technology include its non-invasive technique, the potential to replace or reduce blood draws that contribute to iatrogenic anemia, and real-time monitoring that can prompt clinicians to intervene prior to end organ injury. The most frequently studied regional site is cerebral tissue oxygenation, with several international randomized clinical trials having been performed to evaluate the use of guidelines to monitor and treat abnormal cerebral oxygenation to improve neurological outcomes [2]. Renal oxygenation is the next most studied and is ideal for NIRS monitoring as there is minimal soft tissue between the kidneys and the NIRS sensor placed on the flank. Renal NIRS monitoring can be used to detect abnormal oxygenation and perfusion prior to acute kidney injury (AKI), thus potentially creating a therapeutic window for intervention with renoprotective therapies (i.e., administration of fluids, blood transfusions, vasoactive medications, or methylxanthines). A review of current techniques and past studies on neonatal renal NIRS monitoring have been previously published [3]. However, clinical renal NIRS usage and indications remain poorly understood.

We thus conducted an online survey (approved by Children’s National Hospital IRB, Supplementary file) among all level IV NICUs that are part of the Children’s Hospital Neonatal Consortium (CHNC) in 2022. The 22-question survey was developed by Neonatologists and Pediatric Nephrologists who belong to the NIRS subgroup of the CHNC Kidney Focus Group. The survey was piloted and tested prior to being sent to lead Neonatologists at all CHNC sites. After the initial survey, two reminder emails were sent, and the survey closed two weeks after original distribution.

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Fig. 1: Indications and Limitations for use of Renal Near Infrared Spectroscopy monitoring in the Neonatal Intensive Care Unit.

Data availability

Data is available for sharing upon reasonable request dependent on IRB approval and data sharing agreements between institutions.

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Acknowledgements

We are indebted to the following CHNC participating institutions that serve the infants and their families; these institutions (and their site sponsors) also have invested in and continue to participate in the Children’s Hospital’s Neonatal Database (CHND): 1. Alfred I. duPont Hospital for Children, Wilmington, DE. 2. All Children’s Hospital Johns Hopkins Medicine, St. Petersburg, FL. 3. American Family Hospital, Madison, WI. 4. Advent Health for Children, Orlando, FL. 5. Ann & Robert H. Lurie Children’s Hospital of Chicago; Chicago, IL. 6. Arkansas Children’s Hospital. 7. Boston Children’s Hospital; Boston, MA. 8. Brenner Children’s Hospital, Winston-Salem, NC. 9. Cincinnati Children’s Hospital; Cincinnati, OH. 10. Children’s Healthcare of Atlanta at Egleston; Atlanta, GA. 11. Children’s Healthcare of Atlanta at Scottish Rite; Atlanta, GA. 12. Children’s Hospital and Medical Center, Omaha, NE. 13. Children’s Hospital Colorado, Denver. 14. Children’s Hospital of Orange County; Orange, CA. 15. Children’s Hospital of Philadelphia. 16. Children’s Hospital of Pittsburgh of UPMC; Pittsburgh, PA. 17. Children’s Hospital of Wisconsin, Milwaukee, WI. 18. Children’s Medical Center Dallas, TX. 19. Children’s Mercy Hospitals and Clinics, Kansas City. MO. 20. Children’s National Medical Center, Washington, DC. 21. Children’s of Alabama, Birmingham, AL. 22. Children’s Hospital of Los Angeles, Los Angeles, CA. 23. Children’s Hospital of Michigan, Detroit, MI. 24. Connecticut Children’s Medical Center, Hartford, CT. 25. Cook Children’s Medical Center, Fort Worth, TX. 26. Hospital for Sick Children, Toronto, Ontario, Canada. 27. Le Bonheur Children’s Hospital, Memphis, TN. 28. Nationwide Children’s Hospital, Columbus, OH. 29. Nemours Children’s Hospital, Orlando, FL. 30. Oklahoma Children’s Hospital, Oklahoma City, OK. 31. Primary Children’s Hospital, Salt Lake City, UT. 32. Rady Children’s Hospital, San Diego, CA. 33. Riley Children’s, Indianapolis, IN. 34. Seattle Children’s Hospital, Seattle, WA. 35. Stead Family Children’s Hospital, Iowa City, IO. 36. St Christopher’s Hospital for Children, Philadelphia, PA. 37. St. Louis Children’s Hospital, St. Louis, MO. 38. Texas Children’s Hospital, Houston; Houston, TX. 39. UCSF Benioff Children’s Hospital Oakland; Oakland, CA.

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Author notes

  1. A full list of members and their affiliations appears in the Supplementary Information.

Authors and Affiliations

  1. Department of Pediatrics, Division of Neonatology, University of Wisconsin, Madison, WI, USA

    Matthew W. Harer

  2. Department of Pediatrics, Division of Neonatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Jennifer A. Rumpel & Nidhi Agarwal

  3. Department of Pediatrics, Division of Neonatology, University of Alabama Birmingham, Birmingham, AL, USA

    Christine Stoops

  4. Department of Pediatrics, Division of Neonatology, Cincinnati Children’s Hospital and the University of Cincinnati, Cincinnati, OH, USA

    Cara L. Slagle

  5. Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Indiana University, Indianapolis, IN, USA

    Brianna Liberio

  6. Department of Pediatrics, Division of Neonatology, University of Missouri—Kansas City, School of Medicine, Kansas City, MO, USA

    John Daniel

  7. Division of Neonatology, Children’s National Hospital, Washington, DC, USA

    Suma B. Hoffman, Khodayar Rais-Bahrami & Sofia Perazzo

  8. Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA

    Suma B. Hoffman, Khodayar Rais-Bahrami & Sofia Perazzo

  9. Baylor College of Medicine, Department of Pediatrics, Division of Neonatology, Houston, TX, USA

    Mona G. Khattab

Authors
  1. Matthew W. Harer
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  2. Jennifer A. Rumpel
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  3. Christine Stoops
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  4. Cara L. Slagle
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  5. Brianna Liberio
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  6. John Daniel
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  7. Suma B. Hoffman
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  8. Nidhi Agarwal
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  9. Mona G. Khattab
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  10. Khodayar Rais-Bahrami
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  11. Sofia Perazzo
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Consortia

Children’s Hospitals Neonatal Consortium Kidney and Urology Focus Group

  • Matthew W. Harer
  • , Jennifer A. Rumpel
  • , Christine Stoops
  • , Cara L. Slagle
  • , Brianna Liberio
  • , John Daniel
  • , Suma B. Hoffman
  • , Nidhi Agarwal
  • , Mona G. Khattab
  • , Khodayar Rais-Bahrami
  •  & Sofia Perazzo

Contributions

MWH: significant contributions to the design and conception, data analysis and interpretation, drafting the manuscript, critical revision of the manuscript and final approval. SP, JAR: contributions to the design and conception, data analysis, interpretation, and critical revision of the manuscript. CS, BL, CLS, JD, SBH, NA, MGK: contributions to design and revision of the manuscript.

Corresponding author

Correspondence to Matthew W. Harer.

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Competing interests

The authors have no financial disclosures. Dr. Harer is supported by the Wisconsin Partnership Program New Investigator Award and an institutional KL2 award (KL2TR002374.).

Consent for publication

Patient consent was not required for this study, IRB approved at Children’s National.

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Harer, M.W., Rumpel, J.A., Stoops, C. et al. Current state of renal NIRS monitoring in the NICU: results from a CHNC Survey. J Perinatol 43, 1047–1049 (2023). https://doi.org/10.1038/s41372-023-01648-x

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