Effect of different assumptions for brain water content on absolute measures of cerebral oxygenation determined by frequency-domain near-infrared spectroscopy in preterm infants: an observational study

BACKGROUND: Brain-water content (BWC) decreases with maturation of the brain and potentially affects parameters of cerebral oxygenation determined by near-infrared spectroscopy (NIRS). Most commercially available devices do not take these maturational changes into account. The aim of this study was to determine the effect of different assumptions for BWC on parameters of cerebral oxygenation in preterm infants. METHODS: Concentrations of oxy-, deoxy- and total hemoglobin and regional cerebral oxygen saturation (rcStO(2)) were calculated based on absolute coefficients of absorption and scattering determined by multi-distance Frequency-Domain-NIRS assuming BWCs of 75-95%, which may be encountered in newborn infants depending on gestational and postnatal age. RESULTS: This range of BWC gave rise to a linear modification of the assessed NIRS parameters with a maximum change of 10%. This may result in an absolute overestimation of rcStO(2) by (median (range)) 4 (1–8)%, if the calculation is based on the lowest BWC (75%) in an extremely preterm infant with an anticipated BWC of 95%. CONCLUSION: Clinicians wishing to rely on parameters of cerebral oxygenation determined by NIRS should consider that maturational changes in BWC not taken into account by most devices may result in a deviation of cerebral oxygenation readings by up to 8% from the correct value.