Abstract
Background
We aimed to investigate whether splanchnic tissue oxygen saturation (rsSO2) measured by near-infrared spectroscopy (NIRS) could contribute to the early diagnosis of necrotizing enterocolitis (NEC).
Methods
We retrospectively included infants with suspected NEC, gestational age <32 weeks and/or birth weight <1200 g in the first 3 weeks after birth. We calculated mean rsSO2, cerebral tissue oxygen saturation (rcSO2), variability of rsSO2 (coefficients of variation [rsCoVAR] = SD/mean), and splanchnic-cerebral oxygenation ratio ([SCOR] = rsSO2/rcSO2) in the period around the abdominal radiograph to confirm or reject NEC.
Results
Of the 75 infants, 21 (28%) had NEC (Bell’s stage ≥2). Characteristics of infants with and without NEC differed only on mechanical ventilation and nil-per-os status. RsSO2 tended to be higher and rcSO2 lower in infants with NEC. RsCoVAR (median [range]) was lower (0.11 [0.03–0.34]) vs. 0.20 [0.01–0.52], P = 0.002) and SCOR higher (0.64 [0.37–1.36]) vs. 0.47 [0.16–1.09], P = 0.004) in NEC infants. Adjusted for postnatal age, mechanical ventilation, and nil-per-os status, a 0.1 higher rsCoVAR decreased the likelihood of NEC diagnosis with likelihood ratio (LR) 0.38 (95% CI 0.18–0.78) and a 0.1 higher SCOR increased it with LR 1.28 (1.02–1.61).
Conclusions
Using NIRS, high SCOR may confirm NEC and high variability of rsSO2 may rule out NEC, when suspicion arises.
Impact
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Near-infrared spectroscopy may contribute to the diagnosis of necrotizing enterocolitis.
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When clinical signs are present a high splanchnic-cerebral oxygenation may indicate necrotizing enterocolitis.
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A low splanchnic-cerebral oxygenation ratio and high variability of splanchnic tissue oxygen saturation may rule out necrotizing enterocolitis.
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Whether a bedside real-time availability of the splanchnic-cerebral oxygenation ratio and variability of splanchnic tissue oxygen saturation improves NEC diagnosis needs to be further investigated.
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Acknowledgements
This study was part of the research programme of the Graduate School of Medical Sciences, Research Institutes SHARE, University of Groningen. We want to thank the NIRS team, the nurses, and the medical staff of the neonatology department for their contribution in collecting data of this study. M.v.d.H. was financially supported by a grant from the Junior Scientific Master Class of the University of Groningen.
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M.v.d.H. and E.M.W.K. were involved in the design and execution of the study. All other authors were involved in the final consensus process of the protocol and contributed significantly to the manuscript. M.v.d.H. drafted the manuscript and all other authors read, edited, and approved the final manuscript for publication.
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Due to the retrospective character of the study, no informed consent from the participant’s legal guardian was required. Nevertheless, none of the participant’s legal guardians objected to participate during admission when they were offered this option.
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van der Heide, M., Hulscher, J.B.F., Bos, A.F. et al. Near-infrared spectroscopy as a diagnostic tool for necrotizing enterocolitis in preterm infants. Pediatr Res 90, 148–155 (2021). https://doi.org/10.1038/s41390-020-01186-8
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DOI: https://doi.org/10.1038/s41390-020-01186-8
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