Cerebral Oxygenation Monitoring Using Near-Infrared Spectroscopy in Delivery Room Resuscitation of Neonates: A Systematic Review

This systematic review evaluates near-infrared spectroscopy (NIRS) in monitoring cerebral oxygenation during neonatal delivery room resuscitation. The objective was to assess its impact on cerebral regional oxygen saturation (CrSO₂), intraventricular hemorrhage (IVH) incidence, and time to stabilization compared to standard protocols. Using a Population, Intervention, Comparison, Outcome (PICO) framework, we searched PubMed, Embase, Cochrane Library, Scopus, and Web of Science from January 2010 to July 2025 for randomized controlled trials (RCTs) and observational studies in English, focusing on term and preterm neonates requiring resuscitation. Exclusions included non-human studies, non-English articles, case reports, and non-delivery room settings. Two reviewers screened 3,500 studies, with 700 remaining after deduplication, and four high-quality primary studies were included after rigorous selection. Quality was assessed using the Cochrane Risk of Bias Tool for RCTs and the Newcastle-Ottawa Scale for observational studies. Due to heterogeneity in study designs, NIRS devices, and outcomes, a narrative synthesis was conducted. Results showed NIRS feasibility, with CrSO₂ rising from 36-37% at one minute to 52-84% by seven to 15 minutes in preterm neonates. One RCT reported a 55.4% reduction in cerebral hypoxia burden (p<0.05), and one cohort study showed lower CrSO₂ in neonates with IVH (p=0.003). IVH incidence was 4-12% (50% in one study), with limited control group data. Stabilization time data were limited. No studies addressed India's high-risk neonatal population or long-term outcomes. NIRS shows promise for optimizing cerebral oxygenation and identifying IVH risk, but larger RCTs, standardized protocols, and India-specific studies are needed.