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  • Clinical Research Article
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Preterm infants variability in cerebral near-infrared spectroscopy measurements in the first 72-h after birth

Pediatric Research volume 94, pages 1408–1415 (2023)Cite this article

Abstract

Background

Cerebral near-infrared spectroscopy is a non-invasive tool used to measure regional cerebral tissue oxygenation (rScO2) initially validated in adult and pediatric populations. Preterm neonates, vulnerable to neurologic injury, are attractive candidates for NIRS monitoring; however, normative data and the brain regions measured by the current technology have not yet been established for this population.

Methods

This study’s aim was to analyze continuous rScO2 readings within the first 6–72 h after birth in 60 neonates without intracerebral hemorrhage born at ≤1250 g and/or ≤30 weeks’ gestational age (GA) to better understand the role of head circumference (HC) and brain regions measured.

Results

Using a standardized brain MRI atlas, we determined that rScO2 in infants with smaller HCs likely measures the ventricular spaces. GA is linearly correlated, and HC is non-linearly correlated, with rScO2 readings. For HC, we infer that rScO2 is lower in infants with smaller HCs due to measuring the ventricular spaces, with values increasing in the smallest HCs as the deep cerebral structures are reached.

Conclusion

Clinicians should be aware that in preterm infants with small HCs, rScO2 displayed may reflect readings from the ventricular spaces and deep cerebral tissue.

Impact

  • Clinicians should be aware that in preterm infants with small head circumferences, cerebral near-infrared spectroscopy readings of rScO2 displayed may reflect readings from the ventricular spaces and deep cerebral tissue.

  • This highlights the importance of rigorously re-validating technologies before extrapolating them to different populations.

  • Standard rScO2 trajectories should only be established after determining whether the mathematical models used in NIRS equipment are appropriate in premature infants and the brain region(s) NIRS sensors captures in this population, including the influence of both gestational age and head circumference.

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Fig. 1: Consort diagram.
Fig. 2: Estimated NIRS sensor measurement by head circumference and gestational age.
Fig. 3: rScO2 trajectories by head circumference and gestational age.
Fig. 4: Factors that influence rScO2 measurements.

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Data availability

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request. De-identified NIRS data are subject to an institutional data use agreement. Fetal T2 MRI brain images in the Harvard Fetal Brain Atlas are available online at http://crl.med.harvard.edu/research/fetal_brain_atlas/.

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Acknowledgements

We would like to thank the nursing staff at the University of Washington Medical Center in Seattle, Washington, who provided excellent bedside care to the neonates throughout data collection.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The study was supported by an internal grant provided by the Division of Child Neurology at Seattle Children’s Hospital.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, WA, USA

    Sarah E. Kolnik, Olivia Brandon, Mihai Puia-Dumitrescu, Gregory Valentine, Janessa B. Law, Niranjana Natarajan, Thomas R. Wood & Ulrike Mietzsch

  2. Elson S. Floyd College of Medicine, Spokane, WA, USA

    Rebecca Marquard

  3. Department of Neurology, Division of Child Neurology, University of Washington School of Medicine, Seattle, WA, USA

    Niranjana Natarajan

  4. Department of Radiology, University of Washington, Seattle, WA, USA

    Manjiri Dighe

  5. Division of Engineering and Mathematics, School of STEM, University of Washington, Bothell, WA, USA

    Pierre D. Mourad

  6. Department of Neurological Surgery, School of Medicine, University of Washington, Seattle, WA, USA

    Pierre D. Mourad

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  1. Sarah E. Kolnik
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Contributions

Substantial contributions to the conception and design, acquisition of data, or analysis and interpretation of data: S.E.K., R.M., O.B., J.B.L., N.N., M.D., T.R.W., P.D.M., U.M. Drafting the article or revising it critically for important intellectual content: S.E.K., T.R.W., P.M., U.M. Final approval of the version to be published: all authors.

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Correspondence to Sarah E. Kolnik.

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Kolnik, S.E., Marquard, R., Brandon, O. et al. Preterm infants variability in cerebral near-infrared spectroscopy measurements in the first 72-h after birth. Pediatr Res 94, 1408–1415 (2023). https://doi.org/10.1038/s41390-023-02618-x

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