Comparison of Near-Infrared Spectroscopy and Traditional Parameters for Monitoring Neonates with Aortic Coarctation.

In neonates with aortic coarctation (CoA), near-infrared spectroscopy (NIRS) may be utilized to asses for impaired end-organ perfusion. To test the utility of Cerebral (CSat) and renal (RSat) oxygen saturations compared to traditional parameters in determining the need for surgical intervention in neonates with significant risk for CoA. This single-center, retrospective cohort study included newborns > 34 weeks gestation with fetal echocardiographic diagnosis of moderate or high-risk CoA admitted to the neonatal intensive care unit under an institutional arch watch protocol. NIRS and traditional monitoring values (pre- and post-ductal oxygen saturation, 4-extremity blood pressure, urine output, blood gas, and lactate) were measured for seven days. Fifty patients met the inclusion criteria, and 16 required surgical repair. Univariate analysis showed no significant difference between surgical and non-surgical patients for pre- and post-ductal saturations, arterial blood pH, or base deficit. CSat and RSat were significantly lower in surgical patients on days 2–6 and 1, 2, and 4, respectively. ROC analysis of NIRS measures on day 3 showed AUC of 0.77 for surgical repair. CSat and RSat values were significantly decreased in infants with CoA requiring surgery. The addition of NIRS monitoring may better identify patients who require surgical intervention than traditional monitoring alone.