A novel multimodal computational system using near-infrared spectroscopy to monitor cerebral oxygenation during assisted ventilation in CDH patients

J Pediatr Surg. 2016 Jan;51(1):38-43. doi: 10.1016/j.jpedsurg.2015.10.017. Epub 2015 Oct 23.


Background/purpose: The aim of this study was to create a computational simulator to serve as an early alert system for cerebral hypoxemia prior to the onset of clinical symptoms.

Methods: Neonates with congenital diaphragmatic hernia (Jan 2010-Dec 2014) were recruited to collect continuous measurements of cerebral tissue oxygen saturation (cStO2) using a near-infrared spectroscopy (NIRS) device (FORE-SIGHT®, CASMED). Clinicians were blinded to NIRS data and treated infants based on pre-established clinical protocols. Charts were reviewed retrospectively to identify clinical events of hypoxemia (spontaneous, sustained decrease in preductal SpO2<85% leading to ventilator changes). We developed a computational algorithm that determined baseline values, variability and event data for each patient.

Results: Twenty-three of 36 patients enrolled met data criteria. The algorithm anticipated an event at least 15 minutes prior to the event in 77% of cases, with an average pre-event detection of 47 minutes (range 16-122 minutes). Post-event StO2 (SpO2<85%) was determined to be 63.7% ± 11.7. In this computational model, the sensitivity to distinguish low states of cerebral perfusion was 94% with a specificity of 96%.

Conclusion: We have developed a computational algorithm with an early warning system that has the potential of being translated into a real-time clinical interface that may improve management of neonates.

Keywords: CDH; Cerebral oxygenation; Near infrared spectroscopy.

Publication types

  • Observational Study

MeSH terms

  • Algorithms
  • Biomarkers / metabolism
  • Brain / metabolism*
  • Decision Support Techniques
  • Hernias, Diaphragmatic, Congenital / complications
  • Hernias, Diaphragmatic, Congenital / metabolism
  • Hernias, Diaphragmatic, Congenital / therapy*
  • Humans
  • Hypoxia / diagnosis*
  • Hypoxia / etiology
  • Hypoxia / metabolism
  • Infant, Newborn
  • Multimodal Imaging
  • Neurophysiological Monitoring / methods*
  • Oxygen / metabolism*
  • Respiration, Artificial*
  • Retrospective Studies
  • Sensitivity and Specificity
  • Spectroscopy, Near-Infrared*


  • Biomarkers
  • Oxygen