Low Splanchnic Oxygenation and Risk for Necrotizing Enterocolitis in Extremely Preterm Newborns

Palleri, Elena; Wackernagel, Dirk; Wester, Tomas; Bartocci, Marco

doi:10.1097/mpg.0000000000002761

Cited by 23 publications

(10 citation statements)

References 25 publications

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“…Infants with necrotizing enterocolitis (Bell's stage ≥2) 18 were also excluded because of the association of r s SO 2 in the first week after birth and subsequent development of necrotizing enterocolitis. 7,19 Data from infants who developed clinical sepsis (sepsis symptoms with a positive blood culture and/or C-reactive protein >20 mg/L) were excluded from 1 day prior to diagnosis and all subsequent days because intestinal perfusion has been shown to be different during these days in these infants. 20 In case an infant died, data from that day were excluded.…”

Section: Patient Populationmentioning

confidence: 99%

Regional splanchnic oxygen saturation for preterm infants in the first week after birth: reference values

et al. 2021

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BACKGROUND: Near-infrared spectroscopy is used in the assessment of regional splanchnic oxygen saturation (r s SO 2 ), but solid reference values are scarce. We aimed to establish reference values of r s SO 2 for preterm infants during the first week after birth, both crude and modeled based on predictors. METHODS: We included infants with gestational age (GA) <32 weeks and/or birth weight <1200 g. We excluded infants who developed necrotizing enterocolitis or sepsis or who died. In the first week after birth, we determined a daily 2-h mean of r s SO 2 to assess its associations with sex, GA, postnatal age (PNA), small-for-gestational age (SGA) status, patent ductus arteriosus, hemoglobin, nutrition, and head circumference at birth and translated those into a prediction model. RESULTS: We included 220 infants. On day 1, the mean ± SD r s SO 2 value was 48.2% ± 16.6. The nadir of r s SO 2 was on day 4 (38.7% ± 16.6 smoothed line) to 5 (37.4%±17.3, actual data), after which r s SO 2 increased to 44.2% ± 16.6 on day 7. The final model of the reference values of r s SO 2 included the following coefficients: r s SO 2 = 3.2 − 7.0 × PNA + 0.8 × PNA 2 − 4.0 × SGA + 1.8 × GA. CONCLUSIONS: We established reference values of r s SO 2 for preterm infants during the first week after birth. GA, PNA, and SGA affect these values and need to be taken into account.

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Section: Patient Populationmentioning

confidence: 99%

Regional splanchnic oxygen saturation for preterm infants in the first week after birth: reference values

et al. 2021

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“…The earlier the birth, the higher the incidence, which is not related to whether surgical intervention occurred. The pathogenesis of NEC has not been fully clarified yet, but it has been reported to be related to immune disorders, acute inflammatory cascade reactions, and mucosal barrier function damage ( 20 ). This study found that the concentrations of CRP, I-FABP, IL-6, PCT, and SAA in the operation group were notably higher, indicating that the inflammatory reaction and intestinal mucosa damage in NEC patients were more serious.…”

Section: Discussionmentioning

confidence: 99%

Predictive value of serum markers in the operation evaluation of neonatal necrotizing enterocolitis

Wang¹,

Jin²,

Su³

et al. 2023

Transl Pediatr

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Background Neonatal necrotizing enterocolitis (NEC) is a common gastrointestinal emergency in newborns. Currently, the pathogenesis of the disease remains unknown. This study aims to determine the application value of serum markers in the selection of operation opportunities for NEC. Methods This study consisted of a retrospective analysis of the clinical data of 150 participants with NEC admitted to Maternal and Child Health Hospital of Hubei Province from March 2017 to March 2022. Participants were assigned to an operation group (n=58) and a nonoperation group (n=92) according to the presence or absence of surgical treatment. Serum sample data for serum C-reactive protein (CRP) and interleukin 6 (IL-6), serum amyloid A (SAA), procalcitonin (PCT), and intestinal fatty acid-binding protein (I-FABP) concentrations were estimated. To compare the differences in overall data and serum markers between the 2 groups, independent factors related to surgical treatment in pediatric patients with NEC were analyzed using logistic regression. The utility of serum markers in selecting surgical options in pediatric patients with NEC was analyzed by constructing a receiver operating characteristic (ROC) curve. Results CRP, I-FABP, IL-6, PCT, and SAA levels were higher in the operation group than in the nonoperation group (P<0.05). Multivariate logistic regression analysis confirmed that CRP, I-FABP, IL-6, PCT, and SAA were independent related factors of NEC surgical remedy (P<0.05). Meanwhile, ROC curve analysis yielded a serum CRP, PCT, IL-6, I-FABP, and SAA area under curve (AUC) of NEC operation timing of 0.805, 0.844, 0.635, 0.872, and 0.864, respectively; a sensitivity of 75.90%, 86.20%, 60.30%, 82.80%, and 84.50%, respectively; and a specificity of 80.40%, 79.30%, 68.35%, 80.40%, and 80.55%, respectively. Conclusions The serum markers CRP, PCT, IL-6, I-FABP, and SAA have certain guiding values in the choice of operation opportunity for pediatric patients with NEC.

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“…Cerebral and splanchnic oxygenation monitoring was performed at postnatal age between days 2 and 6, within 96 h after the first enteral feeding. This population has been described in detail in a previous publication [ 8 ]. A near infrared spectroscopy (NIRS) INVOS 5100c monitor (Medtronic™, (Minneapolis,) USA) with neonatal INVOS sensors was used to measure cerebral (CrSO 2 ) and splanchnic regional oxygenation (SrSO 2 ).…”

Section: Methodsmentioning

confidence: 99%

“…First, demographic and clinical variables were compared between the two cohorts. Second, we divided all infants based on the SrSO 2 30% cut off [ 8 ]. Third, specificity, sensitivity, and positive and negative predictive values with confidence intervals were calculated with a bootstrap cross-validation in R 4.1.2.…”

Section: Methodsmentioning

confidence: 99%

“…In a previous study in extremely preterm infants, it was shown that a 1-hour mean splanchnic oxygenation < 30%, between days 2 and 6 of life, was associated with an increased risk of developing NEC, but this risk seems to change through gestational age [ 8 ]. In order to understand the validity and utility of our previous findings given the relatively low samples size, we chose to combine our cohort with another comparable European cohort to study the clinical usefulness of the splanchnic oxygenation cut off.…”

Section: Introductionmentioning

confidence: 99%

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Clinical usefulness of splanchnic oxygenation in predicting necrotizing enterocolitis in extremely preterm infants: a cohort study

et al. 2023

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Background Impaired intestinal microcirculation seems to play an important role in the pathogenesis of necrotizing enterocolitis (NEC). A previous study showed that a SrSO2 < 30% is associated with an increased risk of developing of NEC. We aimed to determine the clinical usefulness of the cut off < 30% for SrSO2 in predicting NEC in extremely preterm neonates. Methods This is a combined cohort observational study. We added a second cohort from another university hospital to the previous cohort of extremely preterm infants. SrSO2 was measured for 1–2 h at days 2–6 after birth. To determine clinical usefulness we assessed sensitivity, specificity, positive and negative predictive values for mean SrSO2 < 30. Odds ratio to develop NEC was assessed with generalized linear model analysis, adjusting for center. Results We included 86 extremely preterm infants, median gestational age 26.3 weeks (range 23.0-27.9). Seventeen infants developed NEC. A mean SrSO2 < 30% was found in 70.5% of infants who developed NEC compared to 33.3% of those who did not (p = 0.01). Positive and negative predictive values were 0.33 CI (0.24–0.44) and 0.90 CI (0.83–0.96), respectively. The odds of developing NEC were 4.5 (95% CI 1.4–14.3) times higher in infants with SrSO2 < 30% compared to those with SrSO2 ≥ 30%. Conclusions A mean SrSO2 cut off ≥ 30% in extremely preterm infants between days 2–6 after birth may be useful in identifying infants who will not develop NEC.

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Low Splanchnic Oxygenation and Risk for Necrotizing Enterocolitis in Extremely Preterm Newborns

Cited by 23 publications

References 25 publications

Regional splanchnic oxygen saturation for preterm infants in the first week after birth: reference values

Regional splanchnic oxygen saturation for preterm infants in the first week after birth: reference values

Predictive value of serum markers in the operation evaluation of neonatal necrotizing enterocolitis

Clinical usefulness of splanchnic oxygenation in predicting necrotizing enterocolitis in extremely preterm infants: a cohort study

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