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The light still shines, but not that brightly? The current status of perinatal near infrared spectroscopy

¹ Neonatology Unit, City General Hospital, Stoke on Trent, UK
² Centre for Science and Technology in Medicine, University of Keele, UK

Correspondence to:
Correspondence to:
Dr S A Spencer, Neonatal Unit, North Staffordshire Hospital (City General), Newcastle Road, Stoke on Trent ST4 6QG, UK;
andy.spencer{at}nstaffsh.wmids.nhs.uk

ABSTRACT
Efforts have been made to find new, non-invasive methods for assessing tissue oxygenation and haemodynamics, particularly in the brain of the fetus and the newborn infant. Near infrared spectroscopy (NIRS) is a developmental technique that provides just such a method, allowing calculation of variables such as cerebral blood flow and cerebral blood volume. It can also measure peripheral oxygen consumption. This review is based on our long experience of using NIRS. Basic principles, techniques, validation, and clinical applications are highlighted. Although more than two decades have passed since its introduction, NIRS remains very much a developmental technique, despite technical progression. A great deal more research is required for NIRS to become a routine clinical tool.

Keywords: near infrared spectroscopy; cerebral blood flow; cerebral blood volume; cerebral venous saturation; fractional oxygen extraction; oxygen consumption

Abbreviations: CBF, cerebral blood flow; CBV, cerebral blood volume; CBVR, cerebrovascular reactivity; CNEP, continuous negative extrathoracic pressure ventilation; CSvO₂, oxygen saturation of cerebral venous blood; CW, continuous wave; DO₂, oxygen delivery; DPF, differential path length factor; FIO₂, fractional inspired oxygen concentration; FOE, fractional oxygen extraction; Hb, deoxyhaemoglobin; HbO₂, oxyhaemoglobin; Hbdiff, [HbO₂-Hb]; HbT, total haemoglobin; IM, intensity modulated; IPPV, intermittent positive pressure ventilation; IVH, intraventricular haemorrhage; MRS, magnetic resonance spectroscopy; NIR, near infrared; NIRS, near infrared spectroscopy; PaCO₂, partial pressure of carbon dioxide in arterial blood; PCr, phosphocreatine; Pi, inorganic phosphate; SaO₂, arterial oxygen saturation; TOI, tissue oxygenation index; TOS, tissue oxygen saturation; TPSF, temporal point spread function; TR, time resolved; VLBW, very low birth weight; VO₂; oxygen consumption

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