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

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 2017-2023. Bland-Altman plots, Pearson correlations, and mean biases were analyzed. Result: 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.