Brain oxygenation monitoring during neonatal stabilization and resuscitation and its potential for improving preterm infant outcomes: a systematic review and meta-analysis with Bayesian analysis

Neonatal stabilization and resuscitation in preterm infants are critical interventions. Cerebral tissue oxygen saturation (CrSO2) measured with near-infrared spectroscopy monitoring offers potential benefits by providing real-time information on brain oxygenation. This systematic review aimed to determine if CrSO2-monitoring to guide neonatal resuscitation after birth can improve survival without cerebral injury. A systematic search of MEDLINE, Google Scholar, EMBASE, the Cumulative Index of Nursing and Allied Health Literature, Clinical Trials.gov, and the Cochrane Central Register of Controlled Trials was performed through December 2024. We included only human studies that investigated CrSO2-guided interventions during neonatal resuscitation after birth in preterm infants. A meta-analysis was performed using individual patient data and the Bayesian method. The main outcome assessed was survival without cerebral injury (Study registration:PROSPERO CRD42024512148). Two studies were identified, including a total of 667 preterm infants with less than 34 weeks of gestation, describing CrSO2-guided interventions during neonatal resuscitation. The meta-analysis revealed a high probability of treatment superiority for NIRS-guided interventions that demonstrated improved outcomes compared to standard care, with a 4.5% increase in the rate of survival without cerebral injury (93% probability) and 4.2% reduction of IVH of any grade (94% probability). The risk of bias can be described as low. Conclusion:This meta-analysis suggests that CrSO2-guided interventions may offer a meaningful advantage in preterm infant resuscitation after birth, improving survival without brain injury. The analysis indicates a high probability of a clinically important benefit. This warrants consideration in clinical practice. (Table presented.)