NIRS Monitoring for Neonates With Mild Hypoxic–Ischemic Encephalopathy

BACKGROUND: Despite evidence of cerebral vulnerability in the early postnatal period, neonates diagnosed with mild hypoxic-ischemic encephalopathy (HIE) may not routinely receive continuous neuromonitoring, limiting opportunities for timely neuroprotective interventions. Near-infrared spectroscopy (NIRS) offers continuous, noninvasive monitoring of cerebral oxygenation; however, standardized, nurse-driven, clinical practice guidelines (CPG) for NIRS use in this population are lacking. EVIDENCE ACQUISITION: Guided by the Appraisal of Guidelines for Research and Evaluation II (AGREE II) framework, a systematic review was conducted to identify evidence related to NIRS use in term neonates with mild HIE. Searches of CINAHL, Embase, and MEDLINE were performed from 2019 to 2025. Additional literature sources included clinical guidelines, institutional protocols, and device manuals. Recommendations were synthesized based on cerebral vulnerability in mild HIE, benefits of NIRS monitoring, alignment with nursing scope of practice, and feasibility within neonatal nursing workflows. Final recommendations were endorsed by multidisciplinary stakeholder consensus, resulting in a bedside implementation guide. RESULTS: The CPG recommends 1) NIRS initiation within the first 6 hours of life, 2) standardize sensor site care to ensure data integrity and skin protection, and 3) continuous cerebral monitoring for the first 24 hours in term neonates (≥36 weeks' gestation) with mild HIE. Thresholds for immediate nursing assessment and care escalation are recommended for rScO2 <55% and >85%-90%. IMPLICATIONS FOR PRACTICE AND RESEARCH: Implementation of nurse-driven NIRS CPGs may enhance early detection of cerebral oxygenation abnormalities, improve consistency of neuromonitoring, and support timely neuroprotective care for neonates with mild HIE.