Near-infrared spectroscopy (NIRS) as a tool to prevent cerebral desaturation in newborns with bradycardia events: A systematic review.

OBJECTIVE

Near infrared spectroscopy (NIRS) is a non-invasive tool providing real-time continuous measurement of regional cerebral blood oxygenation and indirect blood flow. The aim of this review is to determine the best evidence to guide the use of NIRS to detect and avoid abnormalities of cerebral perfusion and oxygenation in newborns with bradycardia.

DESIGN

For this systematic review according to PRISMA Statement, we reviewed papers from 2000 to 2023. Research articles, trial, classical articles, observational studies applying NIRS in term and preterm neonates with bradycardia were selected if the title and/or abstract suggested an association between bradycardia or bradycardia associated with apnoea and modification of cerebral oxygenation.

MAIN RESULTS

All included studies (Table 1) were conducted on male and female newborns with gestational age (GA) between 22.6 and 42 weeks and birth weight (BW) between 212 and 3460 g. The definition of bradycardia and cerebral desaturation differed among authors. Seven out of nine papers agreed on association between bradycardia and cerebral desaturation, but no author indicated the cut-off of heart rate (HR) under which cerebral desaturations occur. No study focused on long-term outcome related to cerebral desaturation.

CONCLUSIONS

Even if cut-off values of HR causing cerebral desaturation are not clear and a well-fixed definition of cerebral desaturation has not yet been standardized, the studies demonstrated that bradycardia events lead to reduction of cerebral saturation. Continuous monitoring of HR and cerebral saturation by non-invasive tools could play a key role in the assessment of newborns.