Near-infrared spectroscopy during respiratory support at birth: a systematic review.

Objective: During perinatal transition, compromised cerebral oxygenation may contribute to neonatal morbidity and mortality. Near-infrared spectroscopy measures cerebral regional tissue oxygen saturations (crSO₂) and may guide delivery room respiratory management. This review evaluated whether crSO₂ monitoring in addition to routine assessment (clinical assessment, pulse oximetry +/- ECG) compared with routine assessment alone improves neonatal outcomes.

Design: Systematic review and meta-analysis based on Ovid MEDLINE, Embase, and Cochrane CENTRAL searches (16 February and 5 November 2024).

Setting: Delivery room.

Patients: Newborn infants of all gestations, born via any mode, receiving continuous positive airway pressure and/or intermittent positive pressure ventilation during stabilisation/resuscitation.

Intervention: crSO₂ monitoring with a dedicated treatment guideline in addition to routine assessment compared with routine assessment alone.

Main outcome measures: Survival without neurodevelopmental impairment, survival, severe intraventricular haemorrhage and periventricular leukomalacia (infants <34 weeks); and crSO₂ <10th percentile.

Results: Among 566 articles, 3 articles reporting outcomes from 2 randomised controlled trials (RCTs) (667 preterm infants) were identified. No data were found for survival without neurodevelopmental impairment. We could not exclude benefit or harm from delivery room monitoring of crSO₂ for survival (relative risk (RR) 1.02, 95% CI 0.99 to 1.05), severe intraventricular haemorrhage (RR 0.76, 95% CI 0.38 to 1.54), periventricular leukomalacia (RR 1.93, 95% CI 0.66 to 5.70) (n=667; two RCTs) and crSO₂ <10th percentile (RR 1.00, 95% CI 0.78 to 1.29) (n=60; one RCT).

Conclusions: The limited evidence could not exclude benefit or harm from delivery room monitoring of crSO₂ with a dedicated treatment guideline in preterm infants.