Can Brain Oxygen Monitoring Improve Delivery Room Care? A Systematic Review Explores the Role of NIRS in Newborn Resuscitation
- georgschmoelzer
- Jun 9
- 2 min read
In the critical first minutes after birth, ensuring adequate oxygen delivery to the brain is essential—particularly for preterm infants. Emerging technologies like near-infrared spectroscopy (NIRS) offer clinicians the ability to non-invasively monitor cerebral tissue oxygenation (crSO₂), providing real-time insights into brain oxygen levels during respiratory support. But does this added information improve outcomes?
A recent systematic review and meta-analysis investigated whether using crSO₂ monitoring alongside standard assessments—such as clinical observation, pulse oximetry, and ECG—could improve neonatal outcomes in the delivery room compared to routine care alone.
Study Overview
Objective: Determine if crSO₂ monitoring with a treatment guideline improves survival or reduces brain injury in newborns requiring respiratory support at birth.
Population: Newborn infants of any gestation receiving CPAP or PPV in the delivery room.
Comparison: Routine assessment with vs. without crSO₂ monitoring.
Outcomes:
Survival without neurodevelopmental impairment
Overall survival
Severe intraventricular hemorrhage (IVH)
Periventricular leukomalacia (PVL)
Cerebral oxygenation below the 10th percentile
What Did the Review Find?
Data from 2 RCTs (667 infants) were included.
No studies reported on survival without neurodevelopmental impairment—the most meaningful long-term outcome.
For survival, the relative risk (RR) was 1.02 (95% CI: 0.99–1.05), indicating no significant difference.
Risk of severe IVH may be lower with NIRS-guided care (RR 0.76), but the confidence interval was wide (95% CI: 0.38–1.54).
PVL risk appeared higher with NIRS monitoring (RR 1.93), but again the CI was broad (95% CI: 0.66–5.70), making this finding uncertain.
crSO₂ <10th percentile, a key physiologic threshold, occurred at the same rate in both groups (RR 1.00; 95% CI: 0.78–1.29; n=60).
Interpretation
Despite promising physiological rationale, this review does not provide strong evidence that using crSO₂ monitoring with treatment guidance improves survival or prevents brain injury in preterm infants receiving respiratory support. The results were limited by the small number of trials, lack of long-term outcome data, and wide confidence intervals that prevent clear conclusions.
Conclusion
While near-infrared spectroscopy remains a valuable research and monitoring tool, its routine use in the delivery room to guide respiratory support is not yet supported by high-quality evidence. Larger, well-powered trials with long-term neurodevelopmental follow-up are urgently needed to determine whether this technology should become standard in neonatal care.
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