Near-infrared spectroscopy (NIRS) is a clinical tool that provides a bedside method of noninvasively measuring continuous, "real-time" oxygen consumption and monitoring for potential ischemia of somatic tissues, particularly the brain, kidneys, and intestine in neonates. Although the concept of NIRS seems promising, its implementation into clinical practice has been inconsistent for various reasons, including difficulty in interpreting regional oxygen saturation (rSO2), the wide variation in types of NIRS monitors and probes, the cost of new equipment, different monitoring modalities, large discrepancies in both intra- and interindividual use, a lack of defined universal normative values, and little to no data on outcomes or potentially harmful interventions made based on rSO2 readings. We combine findings from previously published informational articles and studies on the use of NIRS in neonatal medicine to provide a comprehensive overview of this tool and identify potential indications for clinical use.