Can Brain Oxygen Monitoring Improve Delivery Room Care? A Systematic Review Explores the Role of NIRS in Newborn Resuscitation
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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