Near-infrared spectroscopy (NIRS) as a tool to prevent cerebral desaturation in newborns with bradycardia events: A systematic review.
Level 3 - non-randomized controlled study
Systematic review of predominantly observational studies without meta-analysis
PubMed 39734141 · doi:10.1016/j.pedneo.2024.07.011
What was done
A PRISMA-guided systematic review searched literature from 2000 to 2023 for studies evaluating near-infrared spectroscopy (NIRS) to assess cerebral perfusion and oxygenation in term and preterm neonates experiencing bradycardia (with or without apnea). Eligible studies included male and female newborns with gestational ages between 22.6 and 42 weeks and birth weights between 212 and 3460 g.
What was found
Nine studies met inclusion criteria. Seven of the nine papers reported an association between bradycardia events and cerebral desaturation. The abstract reports no quantitative effect estimates or numerical data. No study identified a heart rate threshold below which cerebral desaturations occur, and definitions of both bradycardia and cerebral desaturation varied across the included literature.
Why it matters
Continuous NIRS monitoring demonstrates that neonatal bradycardic episodes are linked to reduced cerebral oxygenation. However, the lack of defined heart rate cut-offs or standardized thresholds currently limits its translation into routine clinical protocols.
Limits
Definitions of bradycardia and cerebral desaturation were inconsistent across the nine included studies. None of the studies evaluated long-term neurodevelopmental or clinical outcomes, and none determined specific heart rate cut-offs triggering desaturation. Total infant participant count and risk-of-bias metrics were not reported in the abstract.
Cited by
- supports In preterm infants, defensive vagal slowing of heart rate can be severe enough to compromise oxygen delivery to the brain.