Department of Physiological and Technological Nursing, College of Nursing, Augusta University, Augusta, Georgia.
Adv Neonatal Care. 2021 Aug 1;21(4):256-266. doi: 10.1097/ANC.0000000000000779.
Acute kidney injury (AKI) affects approximately 30% of infants admitted to the neonatal intensive care unit (NICU), and increases mortality risk by 50%. Current diagnostic criteria (serum creatinine rise with oliguria) cannot detect early-onset AKI, as up to 50% of nephron damage may occur by the time these abnormalities present. Once AKI is established, clinical management is often ineffective; therefore, prevention is key. Near-infrared spectroscopy (NIRS) offers a feasible, noninvasive approach to continuously monitor renal oxygenation trends over time, serving as a surrogate marker for renal perfusion.
To provide an overview of NIRS principles for measuring renal oxygenation, and to describe current evidence of how this technology is being used among infants admitted to the NICU relative to the prediction and identification of AKI.
A comprehensive search of PubMed and CINHAL focused on renal NIRS studies in NICU preterm and term infants was conducted.
Findings from 34 studies were included. In term infants, reduced renal oxygenation correlated to invasive SvO2 monitoring, predicted survivability and AKI. In preterm infants, reduced renal oxygenation was associated with AKI in one study, yet contrasting findings were reported in those with patent ductus arteriosus, including those who received prostaglandin inhibitors. Normative data in all infants were sparse.
Renal NIRS may offer a noninvasive measurement of kidney hypoperfusion that may precede conventional diagnostic measures.
Normative data are lacking, the threshold for renal ischemia is not defined, and consensus guiding clinical treatment based on NIRS data is nonexistent.
急性肾损伤（AKI）影响约 30%入住新生儿重症监护病房（NICU）的婴儿，并使死亡率增加 50%。目前的诊断标准（血清肌酐升高伴少尿）无法检测到早发性 AKI，因为在这些异常出现之前，多达 50%的肾单位损伤可能已经发生。一旦 AKI 确立，临床管理通常效果不佳；因此，预防是关键。近红外光谱（NIRS）提供了一种可行的、非侵入性的方法，可随时间连续监测肾脏氧合趋势，作为肾脏灌注的替代标志物。
提供用于测量肾脏氧合的 NIRS 原理概述，并描述当前关于该技术在 NICU 中接受治疗的婴儿中如何用于预测和识别 AKI 的证据。
对 PubMed 和 CINHAL 进行了全面搜索，重点是关于 NICU 早产儿和足月婴儿肾脏 NIRS 研究的文章。
共纳入 34 项研究。在足月婴儿中，肾脏氧合减少与有创 SvO2 监测、预测存活率和 AKI 相关。在早产儿中，一项研究发现肾脏氧合减少与 AKI 相关，但在动脉导管未闭的婴儿中报告了相反的结果，包括那些接受前列腺素抑制剂治疗的婴儿。所有婴儿的正常数据都很少。
肾脏 NIRS 可能提供一种非侵入性的肾脏低灌注测量方法，可能先于常规诊断措施。
缺乏正常数据，肾缺血的阈值未定义，也没有基于 NIRS 数据指导临床治疗的共识。
