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– Prospective cohort (N = 110) shows darker skin tone is associated with greater negative bias of forehead NIRS (INVOS 5100C) compared to mixed venous saturation.
– Mean bias in the darkest ITA categories was −12.8% versus −2.5% and +0.3% in lighter categories; skin tone (ITA) remained an independent predictor of bias.
– Findings raise concerns that single-device NIRS measurements may systematically misestimate cerebral oxygenation in children with darker skin, with potential implications for patient management and health equity.
