327 - Racial discrepancies in cerebral and renal near-infrared spectroscopy among preterm Infants

Publication Number: 4321.327

Ryan Brewster, Stanford University School of Medicine, Palo Alto, CA, United States; Ilana A. Mendez, Lucile Packard Children's Hospital Stanford, Salinas, CA, United States; Kimberly Reyes Alvarado, Stanford University, Stanford, CA, United States; Valerie Y.. Chock, Stanford University School of Medicine, Palo Alto, CA, United States

Background: Near-infrared spectroscopy (NIRS) provides a non-invasive measure of regional tissue oxygen saturation (rSO2), a key correlate of end-organ perfusion and oxygenation. Skin pigmentation has been shown to impact analogous optical sensing techniques, including pulse oximetry; whether similar racial biases influence NIRS measurements in preterm infants remains poorly understood.

Objective: To evaluate racial differences in cerebral and renal NIRS values among preterm infants

Design/Methods: We retrospectively analyzed cerebral and renal tissue saturation values in all infants < 29 weeks of gestation admitted to a level 4 NICU (Stanford, CA) who underwent routine NIRS monitoring between January 2022 and November 2025. Patient racial classification was obtained from self-reported demographic data in the electronic medical record. Hourly NIRS recordings from birth through the first 72 hours of life were used to calculate individual daily mean NIRS values. We compared aggregated mean daily cerebral and renal rSO2 between white and non-white patients with Student's t-tests. We fit mixed effects multiple linear regression models to evaluate the association between cerebral and renal rSO2 with race, adjusting for sex, day of life, gestational age, 5-minute APGAR score, delivery mode, and birthweight, with infant-level random effects to account for repeated measures

Results: Among 174 patients, the majority were non-white (52.3% Latinx, 25.3% Asian, and 5.7% Black), born via C-section (74.1%) and male (59.2%). The mean gestational age was 26.4 weeks (SD 1.8) (Table 1). Daily mean cerebral rSO2 in non-white patients were significantly lower than white patients through 72 hours of life (p <.05) (Figure). In multivariable models, non-white race was independently associated with a -4.15% (95% confidence interval -6.53 to -1.84, p=.001) difference in cerebral rSO2 (Table 2). There were no significant differences in renal rSO2 between white and non-white patients.

Conclusion(s): Consistent with findings in adults and term infants, estimates of cerebral rSO2 via NIRS were persistently lower in non-white compared to white preterm infants. Racial and ethnic discrepancies in NIRS accuracy may reflect biases in commercial algorithms and contribute to inequities in monitoring and clinical decision-making among minoritized neonatal populations. Future work is needed to prospectively validate these findings with more objective measures of skin pigmentation and characterize the mechanisms underlying racial variation in NIRS measures.

Table 1
Patient characteristics

Table 2
Mixed effects multiple linear regression of association between patient characteristics with cerebral and renal rSO2

Figure 1
Mean daily (A) cerebral and (B) renal rSO2, by race. Asterisks (*P < .05, **P < .01) correspond to statistically significant differences by Student's t-tests.