Title: Splanchnic NIRS monitoring in neonatal care: rationale, current applications and future perspectives

Authors: Silvia Martini and Luigi Corvaglia

Journal: Journal of Perinatology

Date: 22 February 2018

Objective: Provide a complete overview of current neonatal applications for splanchnic NIRS monitoring, to discuss its possible limitations and to suggest future directions for research and clinical applications.

Study Design: Review – Included 36 articles.

Population: Neonatal (Term and Pre-Term)

Result: Current literature provides encouraging evidence in support of SrSO2 reliability in detecting mesenteric hemodynamic changes related to various physiological and pathological conditions in-term and preterm infants.

Conclusion: Splanchnic NIRS monitoring in the neonatal population has so far provided valuable evidence and seems to be a useful tool for investigating splanchnic hemodynamics in both physiological and pathological conditions. Further larger and methodologically uniform studies are necessary in order to assess the effective role of SrSO2 becoming a routine assessment in neonatal clinical practice.

Strategy For Use:

The impairment of blood perfusion and of subsequent oxygen delivery in vital organs is among the major causes underlying global morbidity and mortality; its early detection could thus help prevent clinical complications related to ischemia and hypoxia [3], which, in the neonatal population, can vary from brain damage to gut necrosis.

Doppler assessment is subject to a number of limitations: it requires trained personnel and is prone to operator-dependent bias, it does not allow continuous evaluation and, as it measures blood flow velocity only within large vessels, it does not provide a direct estimate of regional tissue perfusion thus NIRS is more sensitive to the early detection of regional hypoxia and hypoperfusion. For this reason, the role of NIRS as a complementary clinical tool for the assessment of splanchnic hemodynamics has gained increasing interest in recent times.

Doppler findings, together with the pathophysiological mechanisms known to underlie NEC development, have increasingly pushed recent research to investigate the role of SrSO2 in detecting gastrointestinal complications in both animal and human models.

Current literature yields encouraging evidence for the applications that splanchnic NIRS monitoring might find in the neonatal population. From the above data, the information provided by splanchnic NIRS monitoring seems complementary to SMA Doppler ultrasounds and can help to shed light on the physiology of mesenteric hemodynamics during the neonatal period. Furthermore, preliminary evidence seems promising in suggesting a possible role for splanchnic oxygenation in the early detection of intestinal ischemia and in the prediction of feeding intolerance and NEC