The only eligible r and omised clinical trial did not demonstrate any consistent effects of NIRS plus a guideline on the assessed clinical outcomes .
The trial was , however , only powered to detect difference in cerebral oxygenation , not morbidities or mortality .
BACKGROUND Cerebral injury and long-term neurodevelopmental impairment is common in extremely preterm infants .
Cerebral near-infrared spectroscopy ( NIRS ) enables continuous estimation of cerebral oxygenation .
This diagnostic method coupled with appropriate interventions if NIRS is out of normal range ( that is cerebral oxygenation within the 55 % to 85 % range ) may offer benefits without causing more harms .
Therefore , NIRS coupled with appropriate responses to abnormal findings on NIRS needs assessment in a systematic review of r and omised clinical trials and quasi-r and omised studies .
OBJECTIVES To evaluate the benefits and harms of interventions that attempt to alter cerebral oxygenation guided by cerebral NIRS monitoring in order to prevent cerebral injury , improve neurological outcome , and increase survival in preterm infants born more than 8 weeks preterm .
Surveillance protocol for the detection of intracranial abnormalities in premature neonates.
OBJECTIVE To determine the optimal timing of cranial ultrasound scans ( USs ) for identifying preterm neonates weighing less than 1500 g at birth who develop intracranial complications of prematurity . DESIGN / SETTING Observational study at an urban county hospital . METHODS Serial USs from neonates with less than 1500-g birth weight ( BW ) admitted to the neonatal intensive care unit between January 1995 and December 1996 were review ed by a pediatric neuroradiologist in a blinded r and om manner . RESULTS Two hundred forty-eight neonates ( 78 % ) underwent at least 3 USs , 32 ( 10 % ) had 2 USs  and 37 ( 12 % ) only 1 US . The initial US was normal in 156 neonates ( 49 % ) and abnormal in 161 ( 57 % ) . The principal abnormalities included intraventricular hemorrhage ( IVH ) ( n = 74 ) , periventricular echogenicity ( PVE ) ( n = 68 ) , ventriculomegaly ( n = 7 ) , and solitary cysts ( n = 9 ) . Severe IVH ( n = 17 ) occurred in 13 ( 11.4 % ) of 114 neonates at less than 1000-g BW and 4 ( 5 % ) of 79 neonates of BW 1000 to 1250 g. In 11 cases ( 65 % ) , the severe IVH was clinical ly unsuspected . For neonates weighing less than 1000 g , IVH was diagnosed by days 3 to 5 in 10 ( 77 % ) of 13 , by days 10 to 14 in 11 ( 84 % ) of 13 , and by day 28 in all neonates ; for neonates 1001 to 1250 g , IVH was diagnosed in 1 ( 24 % ) of 4 by days 3 to 5 , 2 ( 50 % ) of 4 by days 10 to 14 , and 3 ( 75 % ) of 4 by day 28 . One infant 's condition was diagnosed on routine US before discharge from the hospital . Cystic periventricular leukomalacia ( PVL ) was noted in 9 neonates ; in 4 of the 9 cases , increased PVE was present on the initial US and cyst formation was obvious by the second US . For 4 neonates ( 3 with BW < 1000 g ) , all routine USs were negative and cystic PVL was noted on the predischarge US in these cases . Nonobstructive ventriculomegaly in the absence of IVH or cystic PVL was observed in 14 neonates . In 6 , it was noted on the initial screening US ; in 4 of the cases , it evolved after the third screening US . Two hundred fifty-six neonates had a US before discharge from the hospital ; 181 ( 72 % ) were normal and 75 ( 28 % ) abnormal . Nine significant lesions were identified by the US before discharge from the hospital ( ie , severe IVH [ n = 1 ] , cystic PVL [ n = 4 ] , and ventriculomegaly [ n = 4 ] ) . CONCLUSIONS The following screening protocol is recommended : ( 1 ) Neonates of less than 1000-g BW : initial US on days 3 to 5 ( should identify at least 75 % of cases of IVH and some PVE abnormalities ) ; second US on days 10 to 14 ( should detect at least 84 % of IVH and identify early hydrocephalus and early cyst formation ) ; third scan on day 28 ( should detect all cases of IVH , as well as assess PVE and ventricular size ) ; and final scan before discharge from the hospital ( should detect approximately 20 % of significant late-onset lesions ) . ( 2 ) Neonates of 1000- to 1250-g BW : initial US at days 3 to 5 ( should detect at least 40 % of significant abnormalities ) ; a second scan at day 28 ( should detect at least 70 % of significant abnormalities ) ; and a predischarge scan ( should detect all late-onset significant lesions ) . ( 3 ) Neonates of 1251- to 1500-g BW : an initial scan at days 3 to 5 ; and a second scan before discharge from the hospital if the clinical course is complicated . Arch Pediatr Adolesc Med . 2000;154:822 -
The only eligible r and omised clinical trial did not demonstrate any consistent effects of NIRS plus a guideline on the assessed clinical outcomes .
The trial was , however , only powered to detect difference in cerebral oxygenation , not morbidities or mortality .
BACKGROUND Cerebral injury and long-term neurodevelopmental impairment is common in extremely preterm infants .
Cerebral near-infrared spectroscopy ( NIRS ) enables continuous estimation of cerebral oxygenation .
This diagnostic method coupled with appropriate interventions if NIRS is out of normal range ( that is cerebral oxygenation within the 55 % to 85 % range ) may offer benefits without causing more harms .
Therefore , NIRS coupled with appropriate responses to abnormal findings on NIRS needs assessment in a systematic review of r and omised clinical trials and quasi-r and omised studies .
OBJECTIVES To evaluate the benefits and harms of interventions that attempt to alter cerebral oxygenation guided by cerebral NIRS monitoring in order to prevent cerebral injury , improve neurological outcome , and increase survival in preterm infants born more than 8 weeks preterm .