Department of Pediatrics, Harvard Medical School and Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.
Department of Neonatology, La Paz University Hospital, Madrid, Spain.
Pediatr Res. 2024 Sep;96(4):922-932. doi: 10.1038/s41390-021-01791-1. Epub 2021 Oct 29.
Perioperative applications of near-infrared spectroscopy (NIRS) to monitor regional tissue oxygenation and perfusion in cardiac and noncardiac surgery are of increasing interest in neonatal care. Complex neonatal surgery can impair adequate oxygen delivery and tissue oxygen consumption and increase the risk of neurodevelopmental delay. Coupled with conventional techniques, NIRS monitoring may enable targeted hemodynamic management of the circulation in both cardiac and noncardiac surgical procedures. In this narrative review, we discuss the application of perioperative NIRS in specific neonatal interventions, including surgical intervention for congenital heart defects, definitive closure of the patent ductus arteriosus, neurological and gastrointestinal disorders, and use of extracorporeal membrane oxygenation. We identified areas for future research within disease-specific indications and offer a roadmap to aid in developing evidence-based targeted diagnostic and management strategies in neonates. IMPACT: There is growing recognition that perioperative NIRS monitoring, used in conjunction with conventional monitoring, may provide critical hemodynamic information that either complements clinical impressions or delivers novel physiologic insight into the neonatal circulatory and perfusion pathways.
近红外光谱 (NIRS) 在心脏和非心脏手术中监测局部组织氧合和灌注的围手术期应用在新生儿护理中越来越受到关注。复杂的新生儿手术会损害充足的氧输送和组织氧消耗，并增加神经发育迟缓的风险。与传统技术相结合，NIRS 监测可能使心脏和非心脏手术过程中的循环的血流动力学管理更加具有针对性。在本叙述性综述中，我们讨论了围手术期 NIRS 在特定新生儿干预措施中的应用，包括先天性心脏缺陷的手术干预、动脉导管未闭的确定性关闭、神经和胃肠道疾病以及体外膜氧合的应用。我们确定了在特定疾病指征内的未来研究领域，并提供了一张路线图，以帮助制定针对新生儿的基于证据的有针对性的诊断和管理策略。 影响：人们越来越认识到，围手术期 NIRS 监测与常规监测结合使用，可能会提供关键的血流动力学信息，这些信息要么补充临床印象，要么为新生儿循环和灌注途径提供新的生理见解。
