Abstract
Background: Neonatal hypoxic ischemic encephalopathy (HIE) remains a significant cause of mortality and morbidity worldwide. Cerebral near infrared spectroscopy (NIRS) can provide cot side continuous information about changes in brain hemodynamics, oxygenation and metabolism in real time.Objective: To perform a systematic review of cerebral NIRS monitoring in term and near-term infants with HIE.Search Methods: A systematic search was performed in Ovid EMBASE and Medline database from inception to November 2019. The search combined three broad categories: measurement (NIRS monitoring), disease condition [hypoxic ischemic encephalopathy (HIE)] and subject category (newborn infants) using a stepwise approach as per PRISMA guidance.Selection Criteria: Only human studies published in English were included.Data Collection and Analysis: Two authors independently selected, assessed the quality, and extracted data from the studies for this review.Results: Forty-seven studies on term and near-term infants following HIE were identified. Most studies measured multi-distance NIRS based cerebral tissue saturation using monitors that are referred to as cerebral oximeters. Thirty-nine studies were published since 2010; eight studies were published before this. Fifteen studies reviewed the neurodevelopmental outcome in relation to NIRS findings. No randomized study was identified.Conclusion: Commercial NIRS cerebral oximeters can provide important information regarding changes in cerebral oxygenation and hemodynamics following HIE and can be particularly helpful when used in combination with other neuromonitoring tools. Optical measurements of brain metabolism using broadband NIRS and cerebral blood flow using diffuse correlation spectroscopy add additional pathophysiological information. Further randomized clinical trials and large observational studies are necessary with proper study design to assess the utility of NIRS in predicting neurodevelopmental outcome and guiding therapeutic interventions.
Highlights
The current practice of therapeutic hypothermia (TH) has reduced the disability rates and the severity spectrum of cerebral palsy in newborn infants with hypoxic ischaemic encephalopathy (HIE)
Fifteen studies presented magnetic resonance imaging (MRI) or magnetic resonance spectroscopy (MRS) evidence of injury as short term outcome for comparing with near infrared spectroscopy (NIRS) makers while an equivalent number of studies presented neurodevelopmental follow up data
A frequency-domain near-infrared spectroscopy (FD-NIRS) protocol in a customized commercial FD oximeter was used to measure cerebral oxygenation [35]. This was coupled with a diffuse correlation spectroscopy (DCS) system to measure an additional index of tissue cerebral blood flow (CBF) [41]
Summary
The current practice of therapeutic hypothermia (TH) has reduced the disability rates and the severity spectrum of cerebral palsy in newborn infants with hypoxic ischaemic encephalopathy (HIE). Brain magnetic resonance imaging (MRI) and spectroscopy (MRS) are gold standard tools for prognostication of injury and are optimally performed after completion of TH. These current technologies do not offer all the necessary physiological information that is needed for a continuous assessment of the changes in the newborn brain. Following perinatal hypoxia-ischaemia, significant cerebral haemodynamic and metabolic derangements evolve over time [1,2,3]. This evolution is associated with changes in the brain energy state and underlying neurochemical and neurotoxic state. Cerebral near infrared spectroscopy (NIRS) can provide cot side continuous information about changes in brain hemodynamics, oxygenation and metabolism in real time
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