What is the role of Near-Infrared Spectroscopy (NIRS) in pediatric care?

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Last updated: October 19, 2025 • View editorial policy

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Role of Near-Infrared Spectroscopy (NIRS) in Pediatric Care

Near-Infrared Spectroscopy (NIRS) has potential value in pediatric care for monitoring regional tissue oxygenation, but currently there is insufficient evidence to recommend its routine clinical use for improving mortality or neurological outcomes.

What is NIRS?

  • NIRS is a noninvasive technology that estimates regional tissue oxygenation (rSO₂) by measuring the different absorption spectra of oxygenated and deoxygenated hemoglobin molecules 1
  • NIRS uses adhesive sensors placed on the forehead (for cerebral monitoring) and/or over the abdomen (for renal/mesenteric monitoring) 1, 2
  • Each sensor contains a light source and fiberoptic bundles that detect light absorption and reflection at different tissue depths 1
  • NIRS can detect signals even in situations with no blood flow, such as during cardiopulmonary arrest 1

Current Applications in Pediatrics

  • NIRS can monitor cerebral and somatic oxygenation during and after cardiac surgery 2
  • It is used in preterm infants at risk for necrotizing enterocolitis 2
  • NIRS is applied in newborns with hypoxic-ischemic encephalopathy who have potential risk of impaired tissue oxygenation 2
  • During cardiopulmonary resuscitation (CPR), NIRS may assist in tailoring CPR technique to improve blood flow and oxygen delivery 1

Evidence for NIRS During Cardiac Arrest

  • The 2020 Pediatric Life Support guidelines identified no pediatric randomized controlled trials (RCTs) evaluating NIRS-guided CPR 1
  • Two observational studies in children during CPR showed:
    • One study found that cerebral physiological changes were associated with NIRS measurements during cardiac arrest, increased intracranial pressure reduction, arrest resolution, and after return of spontaneous circulation (ROSC) 1
    • A second small study found an association between higher minimum rSO₂ during CPR and ROSC, but overall survival was too low to detect changes in survival 1
  • Adult systematic reviews suggest higher rSO₂ is associated with higher likelihood of ROSC and survival, while lower rSO₂ is associated with increased mortality 1
  • A trend of rising rSO₂ (between 7% and 15% from baseline measurement) may be a more reliable predictive factor for ROSC than absolute values 1

Limitations and Challenges

  • There is no consensus on the predictive threshold value of rSO₂ for any outcomes 1
  • The level of certainty about the use of NIRS is very low, and the absence of consensus thresholds reduces its clinical usefulness 1
  • The value of monitoring trends in rSO₂ during pediatric resuscitation still requires validation 1
  • A 2024 systematic review with meta-analysis of 25 randomized clinical trials (2606 participants) found very uncertain evidence on the effects of clinical care with access to cerebral NIRS monitoring 3
  • This review showed no significant difference for all-cause mortality, moderate or severe persistent cognitive or neurological deficit, or serious adverse events 3

Current Recommendations

  • The Pediatric Life Support Task Force states that "the confidence in effect estimates is so low that the panel decided that a recommendation was too speculative" 1
  • No treatment recommendation has been made regarding the use of NIRS during pediatric resuscitation 1
  • For children with in-hospital cardiac arrest (IHCA) and an arterial line already in place, hemodynamic-directed CPR might be considered, but more evidence is required 1

Practical Approach to NIRS Monitoring

  • The evolution of rSO₂ values in relation to the starting point is more important for interpretation than absolute values 2
  • Some clinicians suggest defining a baseline cerebral rSO₂ value registered in the awake child prior to anesthesia induction as the lowest acceptable limit during anesthesia and surgery 4
  • NIRS monitoring should be interpreted together with continuously available contributing parameters (blood pressure, heart rate, PaCO₂, and SaO₂) 4

Future Directions

  • NIRS could potentially be increasingly used in multimodal neuromonitoring 2
  • Additional trials with sufficient information size and lower bias risk are required to determine the clinical value of NIRS monitoring 3
  • A randomized controlled trial to demonstrate reduction in brain injury would require approximately 4000 infants to detect a reduction by one-fifth 5

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

5
Research

Has the time come to use near-infrared spectroscopy as a routine clinical tool in preterm infants undergoing intensive care?

Philosophical transactions. Series A, Mathematical, physical, and engineering sciences, 2011

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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