Racial Variation in Cerebral Near-Infrared Spectroscopy Accuracy among Infants in a Cardiac Intensive Care Unit

Abstract

Objective

Pulse oximeters overestimate arterial oxygen saturations in Black versus White adults, children, and infants. While race's impact on near-infrared spectroscopy (NIRS) accuracy is less studied, some adult research suggests decreased accuracy in Black patients. This study investigates the effect of race on NIRS accuracy in infants in a cardiac intensive care unit (CICU).

Study Design

A retrospective chart review was conducted for infants admitted to St. Louis Children's Hospital CICU from 2017 to 2023. Bland–Altman plots, Pearson correlations, and mean biases were analyzed.

Results

About 254 infants (13% Black, 87% White) provided 3,687 central venous oxygen saturation (ScvO₂)–cerebral regional oxygen saturation (rScO₂) pairs. Measurement bias was −3.2% in Black infants and +0.1% in White infants (p < 0.01).

Conclusion

Cerebral NIRS underestimates ScvO₂ in Black infants but maintains negligible measurement bias in White infants. This is the first study to assess race and NIRS accuracy in infants; the difference is statistically significant but not clinically relevant in most contexts.

Key Points

• Light-based measures of oxygen saturation risk interference from melanin.

• Bias of cerebral NIRS is low (−0.6%) against central venous oxygenation.

• Cerebral NIRS error is disproportionate by race, with an underestimate of 3.2% in Black infants.

Keywords

near-infrared spectroscopy - race - accuracy - congenital heart disease - bias

Publication History

Received: 21 April 2025

Accepted: 30 September 2025

Accepted Manuscript online:
03 October 2025

Article published online:
17 October 2025

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