Perioperative Monitoring of Regional Oxygen Saturation in Congenital Heart Disease: Systematic Review of Literature up to 2023

Objective: Pediatric patients with congenital heart disease (CHD) are at risk of non-cardiac complications that impact outcome. Early prognostication is necessary to tailor treatment and improve parent counseling. This systematic review assessed the prognostic value of perioperative near-infrared spectroscopy (NIRS) monitoring of regional oxygen saturation (rSO₂) with regard to brain injury, brain development, neurodevelopment, acute kidney injury (AKI), and necrotizing enterocolitis (NEC) in pediatric CHD patients. Data Sources: PubMed and Embase databases. Study Selection: We searched for original research articles published up to 2023 describing children (younger than 18 yr) with CHD using perioperative rSO₂ monitoring, and reporting their association with at least one of the following outcomes: AKI, NEC, brain injury, brain development, or neurodevelopment. Data Extraction: Ten studies, including a total of 562 patients, were included for brain injury, 4 studies with 229 patients for brain development, 15 studies with 1024 patients for neurodevelopment, 15 studies with 1168 patients for AKI, and 3 studies including 250 patients for NEC. The majority of the studies had a moderate to high risk of bias as assessed by the Cochrane Quality in Prognosis Studies tool. High heterogeneity in study populations and NIRS measurements was found. Data Synthesis: Of the studies we identified, 5 of 10 in brain injury, 3 of 4 in brain development, 10 of 15 in neurodevelopment, 9 of 15 in AKI, and 1 of 3 in NEC reported associations with rSO₂. No meta-analysis could be performed due to heterogeneity. Conclusions: Our findings highlight the need to improve methodological quality and reduce intra- and interstudy heterogeneity. Several methodological recommendations to improve future research were formulated.