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

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).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.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 (<i>p</i> < 0.01).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. · 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..