Introduction: Traumatic brain injury (TBI) is a major cause of pediatric morbidity and mortality. Near-infrared spectroscopy (NIRS), measures regional cerebral oxygen saturation (rSO2), serving as a non-invasive assessment of cerebral perfusion. This study analyzed i) associations between non-invasive rSO2 and invasive intracranial pressure (ICP) and brain tissue oxygenation (PbtO2) ii) rSO2 trends during seizure activity and iii) rSO2 versus hemorrhage location in pediatric TBI.
Methods: This retrospective study used electronic health data from a quaternary children’s hospital (1998-2021) for pediatric patients (age ≤18 years) with moderate or severe TBI (GCS ≤12) who underwent bilateral frontal NIRS monitoring and were intubated for ≥48 hours. Pearson correlation, Mann Whitney U, and Kruskal Wallis tests assessed associations and differences.
Results: The study included 72 patients. Left-sided rSO2 positively correlated with end-tidal CO2 and 6-month Glasgow Outcome-Scale Extended (GOS-E) (p < 0.05); right-sided rSO2 positively correlated with end-tidal CO2, oxygen saturation (SpO2 or pulse oximetry), temperature, and 6-month GOS-E and negatively with supplemental oxygen requirement (FiO2) (p < 0.05). Among accidental TBI patients, right-sided rSO2 positively correlated with hemoglobin and negatively with FiO2 (p < 0.05). In abusive head trauma, bilateral rSO2 positively correlated with end-tidal CO2, SpO2, and temperature, and negatively with FiO2; left-sided rSO2 also positively correlated with 6-month GOS-E (p < 0.05). NIRS rSO2 values did not significantly vary with ICP, PbtO2, presence of clinical or non-clinical seizures confirmed by EEG, or intracranial hemorrhage location. However, rSO2 trended upward during seizure activity regardless of seizure location or with the presence of frontal hemorrhage.
Conclusion : Bilateral NIRS rSO2 positively correlated with end-tidal CO2 and 6-month GOS-E; right-sided rSO2 positively correlated with SpO2 and temperature while negatively with FiO2. NIRS rSO2 had no significant association with invasive ICP and PbtO2, seizure activity, or hemorrhage location. Further role of NIRS in pediatric TBI are warranted.
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