Purpose-A major objective of necrotizing enterocolitis (NEC) research is to devise a noninvasive method of early detection. We hypothesized that abdominal near-infrared spectroscopy (A-NIRS) readings will identify impending NEC in a large animal model.
Methods-Pigletswere prematurely delivered and received parenteral nutrition followed by enteral feedings. Serial A-NIRS readings were obtained for five days, and animals were monitored for NEC. Separately, A-NIRS readings were obtained in healthy piglets to validate the correlation of A-NIRS with splanchnic oxygen delivery.Results-Three of twenty-nine piglets developed NEC. Eleven piglets without NEC died prematurely. Fifteen piglets remained healthy, had normal histologic assessment of their intestines, and served as controls. A-NIRS readings within twelve hours of birth were significantly lower in animals that developed NEC compared to healthy littermates (4% vs 33%, p=0.02). For all time-points measured, ANIRS readings were significantly lower in NEC group compared to controls (21% vs 55%, p<0.001). A-NIRS readings correlated with both decreased pulse oximetry readings during apneic episodes (r=0.96) and increased superior mesenteric artery flow in response to glucagon-like peptide-2 (r=0.67).
Conclusion-A-NIRS is capable of detecting alterations in intestinal oxygenation and perfusion in neonatal piglets and may allow early detection of neonates at risk for NEC.
KeywordsNecrotizing enterocolitis; NEC; Near infra-red spectroscopy; NIRS; A-NIRS; StO 2 ; premature; piglets Necrotizing enterocolitis (NEC) prevails as the most common gastrointestinal emergency of the newborn, affecting one to three children per 1000 live births. Despite diligent pursuit, Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Near-infrared spectroscopy (NIRS) can be used as a non-invasive method of measuring local tissue hemoglobin oxygen saturation, (StO 2 ), at both the capillary bed and the post-capillary venule. It is currently applied to the extremities and abdomen of adults to determine the extent of shock and effectiveness of resuscitation. NIRS is also used in the neonatal intensive care units (NICU), cardiac intensive care units and operating rooms to monitor cerebral oxygenation. Previous studies that applied NIRS to the abdomen of neonates demonstrated that neonates with an acute abdomen have lower cerebro-splanchnic NIRS ratios. In addition, NIRS measurements of the abdomen have also been shown to respond to systemic hemoglobin desaturation during apneic episodes in three infants. Together these studies suggest that abdominal NIR...
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