**8. References**


to solve. Now it is time to prove benefits of using the NIRS technology by decreasing

*"On the one hand, cerebral oximetry can potentially become inexpensive as it is based on technology that can be mass produced. Also, the probe may be miniaturized and integrated with the electronics into a soft 'plaster' that may stick to the skin of the head of tiny infants and need little attention. Solid evidence of benefit to patients will create a large market. Evidence of benefit of an instrument using public domain technology can serve as a platform for healthy competition on user-friendliness and price. On the other hand, what will happen if the clinical use of cerebral oximetry is not developed in a rational, evidence-based format? Then it may become another randomly applied expensive technology. Cerebral oximetry will be supported by anecdotal evidence, expert opinion, active branding and marketing. The consequences include unnecessary disturbances and risks to a very vulnerable group of patients and depletion of scarce healthcare* 

In closing, this chapter is not a manual for patient management. It demonstrated the implementation of a new tool as well as the temptations and hurdles faced by investigators and clinicians using a new promising device, which the author herself understands from

We would like to thank Michelle Carretero for her help with the preparation of this chapter.

Abdul-Khaliq H et al. 2002 Cerebral oxygen monitoring during neonatal cardiopulmonary bypass and deep hypothermic circulatory arrest. *Thorac Card Surg* 50; 77-81 Ancora G, Maranella E, Aceti A, Pierantoni L, Grandi S, Corvaglia L, FaldellaG. Effect of

Baenziger O, Stolkin F, Keel M, von Siebenthal K, Fauchere JC, Das Kundu S, Dietz V,

cerebral oxygenation in preterm neonates: a randomized, controlled trial. Baerts W, Lemmers PM, van Bel F. Cerebral oxygenation and oxygen extraction in the

Bailey SM, Hendricks-Muñoz KD, Wells JT, Mally P. Packed red blood cell transfusion

Bartocci M, Bergqvist LL, Lagercrantz H, Anand KJ. Pain activates cortical areas in the preterm newborn brain. Pain. 2006 May;122(1-2):109-17. Epub 2006 Mar 13.

Neonatology. 2010; 97(3):212-7. Epub 2009 Oct 29.

Neonatology. 2011; 99(1):65-72. Epub 2010 Jul 15.

posture on brain hemodynamics in preterm newborns not mechanically ventilated.

Bucher HU, Wolf M. The influence of the timing of cord clamping on postnatal

preterm infant during desaturation: effects of increasing FiO(2) to assist recovery.

increases regional cerebral and splanchnic tissue oxygen saturation in anemic symptomatic preterm infants. Am J Perinatol. 2010 Jun;27(6):445-53. Epub 2010 Jan

(Greisen et al., 2011)

adverse events in day-to-day patient care and improving outcome.

*resources".* 

**7. Acknowledgment** 

**8. References** 

22.

both observation and personal experience.

Greisen summarized the current situation in an article published recently:


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

2008 Jul;93(4):F261-4. Epub 2008 Feb 5.

Johnson BA 2009 Near-Infrared Spectroscopy in Neonates Before

Nov;96(11):1617-21.

Thorac Surg 72; 187-192

2008 Jan;121(1):142-7

syndrome. *Exp Brain Res* 2006; 173: 458–467.

Feb;65(2):226-30

2010 Apr 13

275

2092.

Jun 28.

179

Neonatal Intensive Care Units – An Example of Implementation of a New Technology 19

Hoffman GM et al. 2004.NIRS-Derived Somatic and Cerebral Saturation Difference Provides

Hoffman GM et al.2007 NONINVASIVE MONITORING OF CARDIAC OUTPUT:

Hoffman GM et al. 2005 Differential effects of carbon dioxide tension on cerebral and

Holsti L, Grunau RE, Shany E. Assessing pain in preterm infants in the neonatal intensive

Hou X et al. 2007 Research on the relationship between brain anoxia at different regional

Hüning BM, Asfour B, König S, Hess N, Roll C. Cerebral blood volume changes during

Hüning BM, Horsch S, Roll C. Blood sampling via umbilical vein catheters decreases

Keating P, Verhagen E, van Hoften J, ter Horst H, Bos AF. Effect of indomethacin infused

Kohlhauser C et al. 2000 Effects of Endotracheal Suctioning on NIRS - Ped Pulmon 29; 270-

Kurth CD et al. 1995 A dynamic phantom brain model for NIRS. Phys Med Biol 40; 2079-

Kurth CD et al. 2001 Cerebral oxygen saturation before congenital heart surgery. Ann

Lemmers PM, Molenschot MC, Evens J, Toet MC, van Bel F. Is cerebral oxygen supply

Lemmers PM, Toet M, van Schelven LJ, van Bel F. Cerebral oxygenation and cerebral

Lemmers PM, van Bel F. Left-to-right differences of regional cerebral oxygen saturation and

Lemmers PMA, Toet M, van Schelven LJ, van Bel F. Cerebral oxygenation and cerebral

syndrome. Exp Brain Res. 2006 Aug; 173(3):458-67. Epub 2006 Feb 28 Lemmers PM, Toet MC, van Bel F. Impact of patent ductus arteriosus and subsequent

compromised in preterm infants undergoing surgical closure for patent ductus arteriosus? Arch Dis Child Fetal Neonatal Ed. 2010 Nov;95(6):F429-34. Epub 2010

oxygen extraction in the preterm infant: the impact of respiratory distress

therapy with indomethacin on cerebral oxygenation in preterm infants. Pediatrics.

oxygen extraction in preterm infants during the first days of life. Pediatr Res. 2009

oxygen extraction in the preterm infant: the impact of respiratory distress

somatic oxygenation assessed by NIRS. Anesthesiology 103; A1374.

Riskof Anaerobic Metabolism Anesthesiology 2004; 101: A1448

Non-Invasive Real-Time Hemodynamic Assessment of Cardiogenic Shock and

BENEFITS OFNIRS TECHNOLOGY Congenital CardToday - Cardiac Output 0607

care unit: moving to a 'brain-oriented' approach. Pain Manag. 2011 Mar 1; 1(2):171-

oxygen saturations and brain damage using NIRS. Physiol Measures 28; 1251-1265

closure by surgery of patent ductus arteriosus. Arch Dis Child Fetal Neonatal Ed.

cerebral oxygenation and blood volume in preterm infants. Acta Paediatr. 2007

over 30 minutes on cerebral fractional tissue oxygen extraction in preterm newborns with a patent ductus arteriosus. Neonatology.2010;98(3):232-7. Epub


Delpy DT, Cope MC, Cady EB, Wyatt JS, Hamilton PA, Hope PL, Wray S, Reynolds EO.

Dotta A et al. 2005 Effects of surgical repair of congenital diaphragmatic hernia on cerebral

Dullenkopf A et al. 2003 measurement of cerebral oxygenation state in anesthetized children using the INVOS 5100 cerebral oximeter. Ped Anesth 13; 384-391.pdf Dullenkopf A et al. 2003 measurement of cerebral oxygenation state in anesthetized children

Edwards AD, Wyatt JS, Richardson C, Delpy DT, Cope M, Reynolds EO. Cotside

Elwell CE, Henty JR, Leung TS, Austin T, Meek JH, Delpy DT, Wyatt JS. Measurement of

Fahnenstich H et al Relative changes in oxyhemoglobin, deoxyhemoglobin and intracranial

Feng W et al. 2001 Influence of overlying tissue and probe geometry on the sensitivity of a

Ferrari M et al. 2004 Principles, techniques and limitations of NIRS. Can J Appl Physiol 29;

Fuchs E, 2011 Brain oxygenation monitoring during neonatal resuscitation of very low birth

Gillam-Krakauer M. et al Abdominal Near-Infrared Spectroscopy Measurements Correlate

Greisen G, Borch K. White matter injury in the preterm neonate: the role of perfusion. *Dev* 

Greisen G et al , Has the time come to use near-infrared spectroscopy as a routine clinical

Hahn GH, Christensen KB, Leung TS, Greisen G. Precision of coherence analysis to detect

Hess JR. Seeing red. Transfusion. 2010 Jun;50(6):1170-2. [Link to PubMed for fulltext: PMID:

Hoffman GM et al. 2003 Two-site NIRS transcutaneous oximetry as a non-invasive indicator of mixed venous oxygen saturation in cardiac neonates. Anesthesiology 99; A1393

measurement of cerebral blood flow in ill newborn infants by near infrared

CMRO2 in neonates undergoing intensive care using near infrared spectroscopy.

blood volume during surfactant replacement therapy in infants with respiratory

weight infants, Journal of Perinatology advance online publication 18 August 2011;

between cerebrovascular dysautoregulation and arterial blood pressure in the premature infant. *Journal of Perinatology* (2011) 31, 722–729; doi:10.1038/jp.2011.17;

with Superior Mesenteric Artery Doppler Ultrasound in Very Preterm Infants, PAS

tool in preterm infants undergoing intensive care? Phil. Trans. R. Soc. *A* (2011) 369,

cerebral autoregulation by near-infrared spectroscopy in preterm infants. J Biomed

Relationship

spectroscopy. Scand J Clin Lab Invest Suppl. 1987;188:9-17.

hemodynamics evaluated by NIRS. J Ped Surg 40; 1748-1752

using the INVOS 5100 cerebral oximeter. Ped Anesth 13; 384-391

distress syndrome. Dev Pharmacol Ther. 1991; 17(3-4):150-3.

Gilmore MM, Stone BS, Shepard JA, Czosnyka M, Easley RB, Brady KM.

NIR tissue oximeter. Physiol Measures 22; 201-208.pdf

spectroscopy. Lancet. 1988 Oct 1;2(8614):770-1.

Adv Exp Med Biol. 2005;566:263-8.

463-487.

20598099.

doi: 10.1038/jp.2011.110

published online 3 March 2011

*Neurosci* 2001; 23: 209–212.2005

4440–4451 doi:10.1098/rsta.2011.0261

Opt. 2010 May-Jun; 15(3):037002.

2011, E-PAS20111421.216

Cerebral monitoring in newborn infants by magnetic resonance and near infrared


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

Child Fetal Neonatal Ed. 2005 Jan; 90(1):F75-6.

F192.

Oct;23(6):395-400.

Acta Paediatr. 2004 Jan; 93(1):70-5.

venous ECMO patients. J Perinatol 26 628-635

Neonatal Intensive Care Units – An Example of Implementation of a New Technology 21

Naulaers G, Delanghe G, Allegaert K, Debeer A, Cossey V, Vanhole C, Casaer P, Devlieger

Naulaers G, Morren G, Van Huffel S, Casaer P, Devliegar H. Cerebral tissue oxygenation

Noone MA, Sellwood M, Meek JH, Wyatt JS. Postnatal adaptation of cerebral blood flow

Ozawa M, Kanda K, Hirata M, Kusakawa I, Suzuki C. Influence of repeated painful

Feb; 100(2):198-203. doi: 10.1111/j.1651-2227.2010.02022.x. Epub 2010 Oct 8.

Payer C, Urlesberger B, Pauger M, Müller W. Apnea associated with hypoxia in preterm infants: impact on cerebral blood volume. Brain Dev. 2003 Jan;25(1):25-31. Pellicer A, Valverde E, Elorza MD, Madero R, Gayá F, Quero J, Cabañas F. Cardiovascular

Pichler G, Schmölzer G, Müller W, Urlesberger B. Body position-dependent changes in

Pichler G, Urlesberger B, Schmölzer G, Müller W. Effect of tilting on cerebral

Pichler G, van Boetzelar MC, Müller W, Urlesberger B. Effect of tilting on cerebral hemodynamics in preterm and term infants. Biol Neonate. 2001;80(3):179-85. Rais-Bahrami K et al. 2006 Validation of a noninvasive neonatal cerebral oximeter in venous-

Redlin M, Koster A, Huebler M, Boettcher W, Nagdyman N, Hetzer R, Kuppe H, Kuebler

near-infrared spectroscopy. J Thorac Cardiovasc Surg. 2008 Oct;136(4):962-7. Roche-Labarbe N, Carp SA, Surova A, Patel M, Boas DA, Grant PE, Franceschini MA.

Mar; 31(3):341-52. Erratum in: Hum Brain Mapp. 2011 Jul; 32(7):1179. Roll C, Hüning B, Käunicke M, Krug J, Horsch S. Umbilical artery catheter blood sampling

Schrod L, Walter J. Effect of head-up body tilt position on autonomic function and cerebral

low-birthweight infants. Acta Paediatr. 2006 Jan;95(1):68-73.

oxygenation in preterm infants. Biol Neonate. 2002;81(4):255-9.

frequency oscillatory ventilation. Acta Paediatr. 2003 Sep;92(9):1079-84. O'Leary H, Gregas MC, Limperopoulos C, Zaretskaya I, Bassan H, Soul JS, Di Salvo DN, du

related intracranial hemorrhage. Pediatrics. 2009 Jul;124(1):302-9.

Palliation of Hypoplastic Left Heart Syndrome Ann Thorac Surg 2009;87:571–9)

blinded, clinical trial. Pediatrics. 2005 Jun;115(6):1501-12.

H, Van Overmeire B. Ibuprofen and cerebral oxygenation and circulation. Arch Dis

index in very premature infants. *Arch Dis Child Fetal Neonatal Ed* 2002; 87: F189–

using near infrared spectroscopy in extremely preterm infants undergoing high-

Plessis AJ. Elevated cerebral pressure passivity is associated with prematurity-

procedures on prefrontal cortical pain responses in newborns. Acta Paediatr. 2011

support for low birth weight infants and cerebral hemodynamics: a randomized,

cerebral hemodynamics during apnea in preterm infants. Brain Dev. 2001

haemodynamics in preterm infants with periventricular leucencephalomalacia.

WM. Regional differences in tissue oxygenation during cardiopulmonary bypass for correction of congenital heart disease in neonates and small infants: relevance of

Noninvasive optical measures of CBV, StO(2), CBF index, and rCMRO(2) in human premature neonates' brains in the first six weeks of life. Hum Brain Mapp. 2010

volume and velocity: impact on cerebral blood volume and oxygenation in very-


Li J, Zhang G, Holtby H, Guerguerian AM, Cai S, Humpl T, Caldarone CA, Redington AN,

Liao SM, Gregg NM, White BR, Zeff BW, Bjerkaas KA, Inder TE, Culver JP. Neonatal

Limperopoulos C, Gauvreau KK, O'Leary H, Moore M, Bassan H, Eichenwald EC, Soul JS,

Madsen PL et al. 2000 Interference of Cerebral NIR in patients with Icterus Anesth and

McNeill S, Gatenby JC, McElroy S, Engelhardt B. Normal cerebral, renal and abdominal

McQuillen PS, Nishimoto MS, Bottrell CL, Fineman LD, Hamrick SE, Glidden DV, Azakie A,

Meek JH, Tyszczuk L, Elwell CE, Wyatt JS. Cerebral blood flow increases over the first three

Meier SD, Eble BK, Stapleton GE, Morales DL, Chang AC, Andropoulos DB. Mesenteric

Meier SD, Eble BK, Stapleton GE, Morales DL, Chang AC, Andropoulos DB. Mesenteric

Morren G, Naulaers G, Lemmerling P, Van Huffel S, Casaer P, Devlieger H. Quantitation of

Mott AR, Alomrani A, Tortoriello TA, Perles Z, East DL, Stayer SA. Changes in cerebral

Munro MJ, Walker AM, Barfield CP. Hypotensive extremely low birth weight infants have

Nagdyman N, Fleck T, Barth S, Abdul-Khaliq H, Stiller B, Ewert P, Huebler M, Kuppe H,

Menke J et al. 2003 Reproducability of NIRS in neonates - Biol Neonate 83; 6-11

spectroscopy study. J Biomed Opt. 2010 Mar-Apr;15(2):026010

Cardiovasc Surg. 2008 Jan;135(1):83-90, 90.e1-2.

Perinatol. 2011 Jan; 31(1):51-7. Epub 2010 Jun 10.

variables. Pediatr Crit Care Med. 2007 Mar;8(2):154-60.

Oct 17.

Analgesia 90 489-93.pdf

Jan; 78(1):F33-7

2003;510:403-8.

Jul;7(4):346-50.

Perinatol. 2006 Sep;26(9):562-4.

Perinatol. 2006 Sep; 26(9):562-4.

Pediatrics. 2005 Jun;115(6):1794-5

Van Arsdell GS. The influence of systemic hemodynamics and oxygen transport on cerebral oxygen saturation in neonates after the Norwood procedure. J Thorac

hemodynamic response to visual cortex activity: high-density near-infrared

Ringer SA, Di Salvo DN, du Plessis AJ. Cerebral hemodynamic changes during intensive care of preterm infants. Pediatrics. 2008 Nov;122(5):e1006-13. Epub 2008

regional oxygen saturations using near-infrared spectroscopy in preterm infants. J

Adatia I, Miller SP. Regional and central venous oxygen saturation monitoring following pediatric cardiac surgery: concordance and association with clinical

days of life in extremely preterm neonates. Arch Dis Child Fetal Neonatal Ed. 1998

oxyhemoglobin desaturation improves with patent ductus arteriosus ligation. J

oxyhemoglobin desaturation improves with patent ductus arteriosus ligation. J

the concordance between cerebral intravascular oxygenation and mean arterial blood pressure for the detection of impaired autoregulation. Adv Exp Med Biol.

saturation profile in response to mechanical ventilation alterations in infants with bidirectional superior cavopulmonary connection. Pediatr Crit Care Med. 2006

reduced cerebral blood flow. Pediatrics. 2004 Dec;114(6):1591-6. Erratum in:

Lange PE. Relation of cerebral tissue oxygenation index to central venous oxygen saturation in children. Intensive Care Med. 2004 Mar;30(3):468-71. Epub 2004 Jan 13


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

Neonatal Intensive Care Units – An Example of Implementation of a New Technology 23

van den Berg E, Lemmers PM, Toet MC, Klaessens JH, van Bel F. Effect of the "InSurE"

Arch Dis Child Fetal Neonatal Ed. 2010 Sep; 95(5):F352-8. Epub 2010 May 13 Vanderhaegen J, De Smet D, Meyns B, Van De Velde M, Van Huffel S, Naulaers G. Surgical

Vanderhaegen J, Naulaers G, Vanhole C, De Smet D, Van Huffel S, Vanhaesebrouck S,

days of life. Eur J Paediatr Neurol. 2009 Mar;13(2):128-34. Epub 2008 Jul 10. Vanderhaegen J, Vanhaesebrouck S, Vanhole C, Casaer P, Naulaers G. The effect of

Verhagen EA, Keating P, ter Horst HJ, Martijn A, Bos AF. Cerebral oxygen saturation and

Verhagen EA, Ter Horst HJ, Keating P, Martijn A, Van Braeckel KN, Bos AF. Cerebral

Weiss M 2005 NIRS Cerebral Oxygenation Reading in Neonates and Infants and SvO2 - Ped

Wider M. Hemodynamic Management and Regional Hemoglobin Oxygen Saturation (rSO2)

Wolf M, Greisen G. Advances in near-infrared spectroscopy to study the brain of the

Wolf M, Greisen G. Advances in near-infrared spectroscopy to study the brain of the preterm and term neonate. Clin Perinatol. 2009 Dec;36(4):807-34, vi. Review. Wong FY, Barfield CP, Horne RS, Walker AM. Dopamine therapy promotes cerebral flow-

Wong FY, Leung TS, Austin T, Wilkinson M, Meek JH, Wyatt JS, Walker AM. Impaired

spectroscopy. Pediatrics. 2008 Mar;121(3):e604-11. Epub 2008 Feb 4

preterm and term neonate. Clin Perinatol. 2009 Dec; 36(4):807-34

 www.ninds.nih.gov/news\_and\_events/proceedings/nirsworkshop1999.htm Wassenaar EB et al. 2005 Reliability of NIRS in people with dark skin pigmentation. J Clin

by near-infrared spectroscopy. Adv Exp Med Biol. 2010;662:461-6.

oxygenation. Acta Paediatr. 2008 Dec;97(12):1640-4. Epub 2008 Sep 11. Vanderhaegen J, Naulaers G, Van Huffel S, Vanhole C, Allegaert K. Cerebral and systemic

Neonatology. 2010 Jun;98(1):57-63. Epub 2009 Dec 24.

Stroke. 2010 Dec; 41(12):2901-7. Epub 2010 Oct 21.

Monitoring and Computing 19; 195-199.pdf

Pediatrics. 2009 Jul;124(1):294-301

Anesth 15; 102-109.pdf(Validation)

2009

82. Epub 2009 Aug 1.

procedure on cerebral oxygenation and electrical brain activity of the preterm infant. Arch Dis Child Fetal Neonatal Ed. 2010 Jan;95(1):F53-8. Epub 2009 Aug 13. van Hoften JC, Verhagen EA, Keating P, ter Horst HJ, Bos AF. Cerebral tissue oxygen

saturation and extraction in preterm infants before and after blood transfusion.

closure of the patent ductus arteriosus and its effect on the cerebral tissue

hemodynamic effects of intravenous bolus administration of propofol in neonates.

Devlieger H. The effect of changes in tPCO2 on the fractional tissue oxygen extraction--as measured by near-infrared spectroscopy--in neonates during the first

glycaemia on the cerebral oxygenation in very low birthweight infants as measured

extraction in preterm infants with transient periventricular echodensities.

oxygenation in preterm infants with germinal matrix-intraventricular hemorrhages.

of the Brain, Kidney and Gut, Neonatal Intensive Care, Vol. 22 No. 5, September

metabolism coupling in preterm infants. Intensive Care Med. 2009 Oct;35(10):1777-

autoregulation in preterm infants identified by using spatially resolved


Schulz G, Keller E, Haensse D, Arlettaz R, Bucher HU, Fauchère JC. Slow blood sampling

Seri I. Management of hypotension and low systemic blood flow in the very low birth

Slater R, Cantarella A, Gallella S, Worley A, Boyd S, Meek J, Fitzgerald M. Cortical pain

Slater R, Fitzgerald M, Meek J. Can cortical responses following noxious stimulation inform

Sorensen LC, Greisen G. The brains of very preterm newborns in clinically stable condition may be hyperoxygenated. Pediatrics. 2009 Nov;124(5):e958-63. Epub 2009 Oct 19. Sorensen LC, Leung TS, Greisen G. Comparison of cerebral oxygen saturation in premature

Soul JS, Hammer PE, Tsuji M, Saul JP, Bassan H, Limperopoulos C, Disalvo DN, Moore M,

Takami T, Sunohara D, Kondo A, Mizukaki N, Suganami Y, Takei Y, Miyajima T, Hoshika

Tobias JD. Cerebral oximetry using near-infrared spectroscopy aids in the diagnosis of interrupted aortic arch. J Intensive Care Med. 2008 Sep-Oct;23(5):335-7. Toet Mona C. Cerebral Oxygenation and Electrical Activity After Birth Asphyxia: Their

Tracy MB, Klimek J, Hinder M, Ponnampalam G, Tracy SK. Does caffeine impair cerebral

Tsuji M 2000 Cerebral intravascular oxygenation correlates with mean arterial pressure in

Underwood MA, Milstein JM, Sherman MP. Near-infrared spectroscopy as a screening tool

Urlesberger B J et al. Regional Oxygen Saturation of the Brain and Peripheral Tissue during

van Alfen-van der Velden AA, Claessen VP, Hopman JC, Klaessens JH, Sengers RC, Liem

responses in human infants. J Neurosci. 2006 Apr 5;26(14):3662-6.

dependent bias. J Biomed Opt. 2008 Nov-Dec; 13(6):064013

after birth. Pediatr Res. 2010 Nov; 68(5):435-9.

Relation to Outcome *Pediatrics* 2006; 117;333-339

2007;91(2):134-9. Epub 2006 Nov 20.

99(9):1319-23. doi: 10.1111/j.1651-2227.2010.01828.x.

critically ill premature infants. Pediatrics 106; 625-632.

Birth Transition of Term Infants Pediatrics 2010 epub[1].

preterm newborn. Pediatrics. 2003 Jan;111(1):e73-6.

S13.

Review.

Res. 2007 Apr;61(4):467-73.

from an umbilical artery catheter prevents a decrease in cerebral oxygenation in the

weight neonate during the first postnatal week. *Journal of Perinatology* (2006) 26, S8–

us about pain processing in neonates? Semin Perinatol. 2007 Oct;31(5):298-302.

infants by near-infrared spatially resolved spectroscopy: observations on probe-

Akins P, Ringer S, Volpe JJ, Trachtenberg F, du Plessis AJ. Fluctuating pressurepassivity is common in the cerebral circulation of sick premature infants. Pediatr

A. Changes in cerebral perfusion in extremely LBW infants during the first 72 h

oxygenation and blood flow velocity in preterm infants? Acta Paediatr. 2010 Sep;

for patent ductus arteriosus in extremely low birth weight infants. Neonatology.

KD. Changes in cerebral oxygenation and hemodynamics during cranial ultrasound in preterm infants. Brain Dev. 2009 Jun;31(6):427-34. Epub 2008 Oct 5. van Alfen-van der Velden AA, Hopman JC, Klaessens JH, Feuth T, Sengers RC, Liem KD.

Effects of midazolam and morphine on cerebral oxygenation and hemodynamics in ventilated premature infants. Biol Neonate. 2006;90(3):197-202. Epub 2006 May 22. van Bel F et al. 2008 Monitoring Neonatal Regional Cerebral Oxygen Saturation in Clinical

Practice: Value and Pitfalls. Neonatology 2008; 94:237–244 DOI: 10.1159/000151642


www.ninds.nih.gov/news\_and\_events/proceedings/nirsworkshop1999.htm


**2** 

*Japan* 

**Effects of Sleep Debt on Cognitive** 

Kenichi Kuriyama and Motoyasu Honma

*National Center of Neurology and Psychiatry* 

*Department of Adult Mental Health, National Institute of Mental Health,* 

**Performance and Prefrontal Activity in Humans** 

Functional neuroimaging is universally recognized to be a remarkably effective modality for exploring precise brain function. Functional magnetic resonance imaging (fMRI) and positron-emission tomography (PET) are among the most widely used neuroimaging techniques; however, their invasiveness in terms of, for example, exposure to high magnetic fields or radiation, or restriction of body movement during the examination, makes their application difficult in infants, children, and some subjects with an atypical condition.

Near infrared spectroscopy (NIRS), on the other hand, is an alternative neuroimaging modality that is suitable for use with most individuals due to its non-invasive nature. It measures local cortical activity during brain activation. Although NIRS has several limitations compared with fMRI and PET, it is an appropriate and feasible method to use with infants, children, and other subjects such as those who suffer from loss of sleep. Naturally, sleep loss raises some problems related to the subject keeping still yet awake during the examination, but otherwise is a good option. The effects of sleep loss on local cortical activities associated with certain cognitive functioning as assessed by NIRS are the

Information processing in the brain occurs via two different systems, a neuroelectric transmission system and an energy-supplying system to neurons (Guiou et al., 2005). Nutrient arteries around the neurons supply them with blood containing the oxygen and glucose necessary for neural activity. Thus, changes in the ratio of oxygenated hemoglobin (oxy-Hb) to deoxygenated hemoglobin (deoxy-Hb) due to increased blood flow for such activity should be observable in tissues adjacent to the activated neurons. This relationship between neural activity and subsequent changes in cerebral blood flow is known as

Similar to fMRI and PET, NIRS indirectly measures local cortical activity in vivo by measuring the differential concentration between oxy- and deoxy-Hb in the blood vessels. Specifically, it measures the difference in the absorption rate of near-infrared light by oxy-

**1. Introduction** 

topic of this chapter.

**2. Utilization of NIRS for functional brain imaging** 

neurovascular coupling (Guiou et al., 2005; Rasmussen et al., 2009).

