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NIR and Optoacoustic Spectroscopy Cerebral Oximeters Aim to Save Preemies

BioPhotonics
Sep 2016
Cerebral near-infrared spectroscopy oximeters can alert physicians to premature infants’ exposure to hypoxia. As European researchers push to make this technology a standard clinical tool in neonatal intensive care units, an optoacoustic alternative is emerging.

JAMES SCHLETT, EDITOR, james.schlett@photonics.com

In 1985, a team of researchers at Duke University Medical Center in Durham, N.C., pointed out the incongruity that, while the goal of intensive care for preterm newborns is to ensure their brains were receiving sufficient oxygen, neonatal intensive care units (NICUs) lacked a direct, noninvasive way to measure cerebral oxygenation. Instead, NICU staff had to rely on indirect methods, such as monitoring blood-oxygen content and transcutaneous oxygen at sites far from the brain, usually the chest or foot. That compelled the researchers to combine near-infrared (NIR) light and spectroscopy as a way to achieve this goal. In the three-plus decades since then, the need to measure neonate cerebral oxygenation has become no less urgent. Perinatal hypoxia, a deficiency of oxygen in tissue shortly before or after birth, can result in long-term neurological disorders such as cerebral palsy and mental retardation. A 2005 study of infant mortality at an Egyptian NICU found that hypoxic-ischemic encephalopathy, also known as perinatal asphyxia, accounted for nearly one in five deaths (18.8 percent) during an 18-month period. Only deaths due to infections (56.25 percent) and respiratory distress syndrome (26.7 percent) had higher mortality rates. Yet cerebral NIR spectroscopy (NIRS) monitors have not risen to the standard-of-care level in these settings, in part, because of the need for more accurate measurements and for a better understanding of how to respond to them. “I don’t think NIRS cerebral monitoring is standard of care in the NICU as in ‘neonatology,’ certainly not in the U.S. For our institution and many academic institutions, it’s been used as [a] research tool or [in] limited routine neonatal applications,” said Dr. Steve M. Liao, an assistant professor of pediatrics at Washington University School of Medicine in St. Louis.

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GLOSSARY
near-infrared spectroscopy cerebral oximetry
A monitoring technique used to measure the oxygen saturation levels in the brains of patients, commonly in operating room and neonatal intensive care unit settings. The technique, which is based on the Beer-Lambert law, involves the emission of near-infrared light from a probe placed on the patient's forehead and the detection of changes in that light's intensity as it is absorbed by the chromophores oxyhemoglobin, deoxyhemoglobin and cytochrome oxidase in brain tissue.
cameraslasersimagingbiophotonicsspectroscopyJames Schlettcerebral oximetrycerebral oximetercerebral oxygenationhypoxiahypoxic-ischemic encephalopathyHIEperinatal asphyxiahyperoxianeonatal intensive care unitNICUpremature infantnear-infrared spectroscopyNIRSNIRCAS MedicalhamamatsuNonin Medical and MedtronicNoninvasixEquanoxFORE-SIGHTNIROINVOSSafeguarding the BrainS of Our Smallest ChildrenSafeBoosCFeaturesnear-infrared spectroscopy cerebral oximetry

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