**3. Renal NIRS**

Renal rSO2 is higher than cerebral rSO2. McNeill reported that trends in cerebral and renal NIRS during the first 21 days of life mirror each other. Short-term and long-term variability of r-SO2 is small. Saturation changes exceeding >20% from baseline would be reason for concern and may indicate compromised perfusion. Several investigators report use in patients with shock or during surgery. Measurements of the renal rSO2 give insight into peripheral perfusion in general and into renal end-organ function. Using renal rSO2 in conjunction with cerebral rSO2 has been reported to give more and sometimes earlier insights into evolving pathology such as shock. (Cohn et al., 2003; Hoffman et al., 2003, 2004) See figure 2.

Use of Near-Infrared Spectroscopy in the Management of Patients in

bibliography. They are representative of the scope of interest.

ECMO (Benni et al., 2005; Rais-Bahrami et al., 2006)

Respiratory distress (Lemmers et al., 2006; Meek et al., 1998)

**5. Clinical events observed with NIRS** 

Pediatric Surgery (Dotta et al., 2005)

et al. , 2010; Wolf & Greisen , 2009)

Apnea (Payer et al., 2003; Yamamota et al., 2003)

Resuscitation (Baerts et al., 2010, 2011; Fuchs , 2011)

Delivery room (Baenziger et al. ; Urlesberger et al., 2010) Feedings (Baserga et al., 2003; Dave et al., 2008, 2009)

Head ultrasound (van Alfen-van der Velden et al., 2008, 2009)

Intensive Care (Limperopoulos et al., 2008)

et al., 2010, 2011)

**5.1 Unstable neonates** 

Zaramella et al., 2006)

Verhagen et al., 2010)

**5.2 Care giving** 

2010) \*

Neonatal Intensive Care Units – An Example of Implementation of a New Technology 13

clinical and caregiving events and warrants further investigation/characterization. (McNeill

Cortez found higher splanchnic rSO2-s and variability to be associated with a healthy gut, whereas infants with necrotizing enterocolitis, a condition of devastating bowel inflammation,

To further demonstrate the extent of topics and studies, examples of some clinical scenarios are listed. Referenced articles date back to 2000. The articles quoted are found in the

Cardiac disease pre-, intra, post op (Abdul-Khaliq et al., 2002; Hoffman et al., 2003;

Patent Ductus Arteriosus (Hüning et a., 2008; Keating et al., 2010; Lemmers et al., 2008, 2010; Meier et al., 2006; Underwood et al., 2006, 2007; Vanderhaegen et al., 2008;

CNS abnormalities HIE, PVL, PIH (Caicedo et al., 2011; De Smet et al., 2010; Morren et

Greisen & Borch , 2001; Hou et al. 2007; O'Leary et al., 2009; Sorensen & Greisen, 2009; Toet, 2006; van Bel F et al., 2008; Vanderhaegen et al., 2009, 2010; Weiss, 2005; Verhaen

Mechanical Ventilation (Noone et al., 2003; van Alfen-van der Velden et al., 2006;

Blood transfusion (Bailey et al., 2010; Dani et al., 2010; Hess, 2010; van Hoften et al.,

Johnson, 2009; Kurth et al., 2001; Li et al., 2008; Redlin et al., 2008; Seri, 2006)

al., 2003; Munro et al., 2004, 2005; Wolf & Greisen, 2009; Wong et al., 2008)

had low splanchnic rSO2s and decreased variability. (Cortez et al., 2010, 2011)

Fig. 2. Two-site NIRS trends from a patient undergoing resuscitation from hypovolemic/septic shock. Early aggressive resuscitation with fluid and epinephrine to normal regional rSO2 values restored urine output. The effect of changes in pCO2 on cerebral blood flow are evident at 0700. The mirror changes in cerebral and somatic rSO2 suggest that total cardiac output was relatively limited but that the distribution changed.(Hoffman et al., 2007)
