Warren N. Rosenfeld, MD, (L) Chairman, Department of Pediatrics, and Dev Maulik, MD, PhD, (R) Chairman of the Department of Obstetrics and Gynecology, explain the workings of the NIRS unit, which measures the oxygenation level in a baby’s brain.

here are only a few of them in the entire world. Known as the Near Infrared Spec-troscopy Unit - the NIRS machine - this new technology is being studied at Winthrop for its potential to help avoid brain damage in future generations of infants.

At Winthrop, the NIRS machine is used to measure the oxygenated blood flow through the brains of full-term newborn infants, whose mothers have agreed to the test. Eventually, NIRS will be used to measure the blood flow through the brains of premature babies, as well as of the fetus during labor and delivery.

Why the Trial is So Important
“Despite all the advanced monitoring techniques now available, including fetal monitoring, the incidence of brain damage in newborns has not decreased,” observed Warren N. Rosenfeld, MD, Chairman, Department of Pediatrics in the Institute for Family Care at Winthrop.

“Through technology, more premature babies are surviving,” said Dr. Rosenfeld, “but they are still extremely vulnerable to brain damage. Fetal monitoring measures heart rate and the flow of oxygenated blood through the baby’s heart, which helps to save babies’ lives, but tells us nothing about blood flow through the brain.”

Until the advent of NIRS, modern medicine had no way to measure fetal blood flow, either inside the mother’s uterus, or immediately after birth. NIRS answers two critical questions: How much blood is flowing into the brain, and how well oxygenated is the blood?

Winthrop is now one of the few medical institutions worldwide to use NIRS. It was introduced at Winthrop by Dev Maulik, MD, PhD, Chairman of the Department of Obstetrics and Gynecology, in collaboration with Dr. Rosenfeld.

“Recently, fetal oximetry has been shown to be beneficial as a fetal monitoring tool in labor,” Dr. Maulik observed. “The NIRS technology being tested at Winthrop represents a significant advance over fetal pulse oximetry. Where pulse oximetry measures fetal skin oxygenation, the NIRS technology actually measures fetal brain oxygenation. It has the potential to benefit many.”

Timely knowledge of a lack of oxygenation of the brain during labor and delivery would enable obstetricians to mount a necessary intervention to prevent brain damage.

Before the NIRS unit, the measurement of the blood flow in an infant’s brain could only be accomplished invasively.

“The NIRS machine enables us to obtain the data non-invasively,” said Dr. Rosenfeld.

How It Works
The NIRS machine resembles a desktop computer. Light is channeled through the NIRS detector, which is placed on the infant’s head on a lightweight headband, with a small clip on the finger. A visible reddish light, near infrared range, penetrates the thinnest layer of skin, measuring the oxygen in the blood flow just beneath the skin. The light can penetrate thick tissue and even the human skull. The reflected light is measured for oxygenation and the quantity of blood flowing through the brain.

The results appear on the monitor screen. The newborn baby is practically unaware of the test. Several readings per second are obtained.

“We assure the parents that the light is barely detectable by the baby. Though the light is visible, there is no heat, sound or pain,” said Dr. Rosenfeld. “NIRS gives us a moving picture in real time of the oxygenation level of the brain.

“Winthrop has the most highly developed version of the NIRS,” noted Dr. Rosenfeld.

“Once parents are made aware of the purpose of the trial, they are willing to test their newborns with NIRS. They are enthusiastic about the potential of helping future babies,” added Jennifer Zethner, RN, PNP, Pediatric Research Nurse.

For further information about the NIRS trial at Winthrop, call Dr. Warren Rosenfeld, Chairman of the Department of Pediatrics, at (516) 663-2288.