Early cerebral and intestinal oxygenation in the risk assessment of necrotizing enterocolitis in preterm infants

Schat, Trijntje E.; Zoonen, Anne G. J. F. van; Laan, Michelle E. van der; Mebius, Mirthe J; Bos, Arend F.; Hulzebos, Christian V.; Boezen, H. Marike; Hulscher, Jan B F; Kooi, Elisabeth M. W.

doi:10.1016/j.earlhumdev.2019.03.001

Cited by 38 publications

(36 citation statements)

References 32 publications

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“…For the cerebral site, we used the equation FTOE= (S p O 2 ‐CNIRS)/S p O 2 with a similar equation used to assess FTOE at the peripheral muscle site 19 . Assessing oxygen extraction as described has been commonly employed in previous NIRS studies 20,21 …”

Section: Methodsmentioning

confidence: 99%

Effect of ventilator modes on neonatal cerebral and peripheral oxygenation using near‐infrared spectroscopy

2020

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Aim The effect of ventilator modes on regional tissue oxygenation in premature neonates with respiratory distress syndrome (RDS) has yet to be delineated. Previous studies have looked at global oxygen delivery and have not assessed the effects on regional tissue oxygenation. Our aim in this study was to assess such tissue oxygenation in premature babies with RDS in relation to differing modes of ventilation using near‐infrared spectroscopy (NIRS). Methods In 24 stable preterm infants with RDS, undergoing elective wean in ventilator mode, cerebral and muscle tissue oxygenation were assessed using NIRS. Infants were weaned from high‐frequency oscillator or jet ventilator to conventional invasive ventilation (CV) or extubated from CV to non‐invasive mechanical ventilation. Data at 30 minutes prior and at one hour after change in ventilator mode were compared (paired t test). Results In babies changed from high‐frequency oscillation to CV, jet to CV and CV to non‐invasive ventilation, the differences in cerebral NIRS (mean ± SD) were 1.7 ± 9.9%, 2.3 ± 5.7% and 2.1 ± 8.4%, respectively. The concomitant changes in muscle NIRS were −2.9 ± 8.5%, 8.1 ± 9.7% and 3.6 ± 22.4%, respectively. No changes were statistically significant. Conclusion Our data suggest that there is no alteration in regional tissue oxygenation related to ventilator mode in stable preterm infants with improving RDS.

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Section: Methodsmentioning

confidence: 99%

Effect of ventilator modes on neonatal cerebral and peripheral oxygenation using near‐infrared spectroscopy

2020

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“…However, these studies were not intended to test the diagnostic reliability of NIRS in real time but rather to compare r-SO 2 values in newborns with subsequent feeding intolerance 9 or NEC. 10,11 A study involving 10 neonates with acute abdomen requiring surgery, including 5 with NEC, found SCOR to be lower than in 29 controls with normal abdomen. 13 The ratio in cases of acute abdomen was 0.66 that is very close to our value of 0.67 in the whole population.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8] Preliminary studies have suggested that NIRS profiles may differ in terms of mean mesenteric r-SO 2 values and variations in the weeks or days preceding the occurrence of NEC. [9][10][11][12] However, these studies and other works using various NIRS-derived tissue oxygenation indexes 13,14 have not considered the potential role of NIRS in the early diagnosis of NEC in a newborn with gastrointestinal signs pointing to this disease, such as feeding intolerance or bloody stools. The objective of this study was to assess the ability of NIRS to diagnose NEC in neonates with bloody stools and/or abdominal distension.…”

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confidence: 99%

Near-Infrared Spectroscopy: A Tool for Diagnosing Necrotizing Enterocolitis at Onset of Symptoms in Preterm Neonates with Acute Gastrointestinal Symptoms?

Bouhellec

Prodhomme²,

Mura

et al. 2020

Am J Perinatol

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Objective In premature neonates, bloody stools and/or abdominal distension with feeding intolerance may be inaugural signs of necrotizing enterocolitis (NEC). We assessed the ability of near-infrared spectroscopy (NIRS) to distinguish those neonates with NEC soon after the occurrence of these symptoms. Study Design We prospectively collected NIRS measurements of abdominal and cerebral regional tissue oxygen saturation (r-SO2), with values masked by an opaque cover. Two physicians, blinded to the NIRS data, determined whether the gastrointestinal symptoms were related to NEC 10 days after symptom onset. Results Forty-five neonates with mean (standard deviation [SD]) gestational, birth weight and postnatal ages of 31 (3.9) weeks, 1,486 (794) g, and 18 (14) days were enrolled over 30 months. Gastrointestinal symptoms were related to NEC in 23 patients and associated with other causes in 22. Analysis of the 48 hours of monitoring revealed comparable abdominal r-SO2 and splanchnic-cerebral oxygenation ratio (SCOR) in patients with and without NEC (r-SO2: 47.3 [20.4] vs. 50.4 [17.8], p = 0.59, SCOR: 0.64 [0.26] vs. 0.69 [0.24], p = 0.51). Results were unchanged after NIRS analysis in 6-hour periods, and restriction of the analysis to severe NEC (i.e., grade 2 and 3, 57% of the NEC cases). Conclusion In this study, NIRS monitoring was unable to individualize NEC in premature infants with acute gastrointestinal symptoms.

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“…For this prospective, longitudinal, observational, exploratory study we derived patients from a larger observational cohort study at our tertiary referral neonatal intensive care unit (NICU) that aimed to identify prognostic markers for the development of NEC in high-risk neonates (CALIFORNIA-Trial, Dutch Trial Registry NTR4153) [18, 19]. For this trial, all infants who were at high risk of developing NEC, who were born between October 2012 and February 2014, and had been admitted to our NICU were eligible for inclusion.…”

Section: Methodsmentioning

confidence: 99%

The effect of enteral bolus feeding on regional intestinal oxygen saturation in preterm infants is age-dependent: a longitudinal observational study

et al. 2019

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BackgroundThe factors that determine the effect of enteral feeding on intestinal perfusion after preterm birth remain largely unknown. We aimed to determine the effect of enteral feeding on intestinal oxygen saturation (rintSO2) in preterm infants and evaluated whether this effect depended on postnatal age (PNA), postmenstrual age (PMA), and/or feeding volumes. We also evaluated whether changes in postprandial rintSO2 affected cerebral oxygen saturation (rcSO2).MethodsIn a longitudinal observational pilot study using near-infrared spectroscopy we measured rintSO2 and rcSO2 continuously for two hours on postnatal Days 2 to 5, 8, 15, 22, 29, and 36. We compared preprandial with postprandial values over time using multi-level analyses. To assess the effect of PNA, PMA, and feeding volumes, we performed Wilcoxon signed-rank tests or logistic regression analyses. To evaluate the effect on rcSO2, we also used logistic regression analyses.ResultsWe included 29 infants: median (range) gestational age 28.1 weeks (25.1–30.7) and birth weight 1025 g (580–1495). On Day 5, rintSO2 values decreased postprandially: mean (SE) 44% (10) versus 35% (7), P = .01. On Day 29, rintSO2 values increased: 44% (11) versus 54% (7), P = .01. Infants with a PMA ≥ 32 weeks showed a rintSO2 increase after feeding (37% versus 51%, P = .04) whereas infants with a PMA < 32 weeks did not. Feeding volumes were associated with an increased postprandial rintSO2 (per 10 mL/kg: OR 1.63, 95% CI, 1.02–2.59). We did not find an effect on rcSO2 when rintSO2 increased postprandially.ConclusionsOur study suggests that postprandial rintSO2 increases in preterm infants only from the fifth week after birth, particularly at PMA ≥ 32 weeks when greater volumes of enteral feeding are tolerated. We speculate that at young gestational and postmenstrual ages preterm infants are still unable to increase intestinal oxygen saturation after feeding, which might be essential to meet metabolic demands.Trial registrationFor this prospective longitudinal pilot study we derived patients from a larger observational cohort study: CALIFORNIA-Trial, Dutch Trial Registry NTR4153.

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Early cerebral and intestinal oxygenation in the risk assessment of necrotizing enterocolitis in preterm infants

Cited by 38 publications

References 32 publications

Effect of ventilator modes on neonatal cerebral and peripheral oxygenation using near‐infrared spectroscopy

Effect of ventilator modes on neonatal cerebral and peripheral oxygenation using near‐infrared spectroscopy

Near-Infrared Spectroscopy: A Tool for Diagnosing Necrotizing Enterocolitis at Onset of Symptoms in Preterm Neonates with Acute Gastrointestinal Symptoms?

The effect of enteral bolus feeding on regional intestinal oxygen saturation in preterm infants is age-dependent: a longitudinal observational study

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