Monitoring technologies in the neonatal intensive care unit: implications for the detection of necrotizing enterocolitis

Oh, Sungho; Young, Christopher; Gravenstein, Nikolaus; Islam, Saleem; Neu, Josef

doi:10.1038/jp.2010.9

Cited by 34 publications

(29 citation statements)

References 47 publications

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“…However, there is still no consensus regarding its use in current clinical practice [5,6]. Calprotectin is a 36-kDa calcium-and zinc-binding cytosolic protein and a member of the S100 family of proteins, which are released from neutrophils or monocytes and followed by the pro-inflammatory activation of pattern recognition receptors [7].…”

Section: Introductionmentioning

confidence: 99%

Calprotectin levels in necrotizing enterocolitis: a systematic review of the literature

et al. 2016

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Section: Introductionmentioning

confidence: 99%

Calprotectin levels in necrotizing enterocolitis: a systematic review of the literature

et al. 2016

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“…Our preliminary findings suggest that splanchnic tissue oxygenation is differently affected by the two enteral feeding modalities. Reduced splanchnic oxygenation has been proposed to be a predictive marker of feeding intolerance, sepsis (26), splanchnic ischemia (15), and necrotizing enterocolitis (14) in preterm infants. Considering this evidence, the response of splanchnic tissue oxygenation to continuous feeding needs to be carefully evaluated in larger studies focusing specifically on potential consequences related to feeding tolerance.…”

Section: Articlesmentioning

confidence: 99%

“…Since the mid-1980s (12), NIRS has been increasingly used in neonatal intensive care units to assess regional blood flow and tissue oxygen extraction under both physiological and pathological conditions, especially in splanchnic and cerebral regions (9,13,14). Moreover, the relation between splanchnic and cerebral oxygenation has been proposed as a marker for abnormal vascular processes affecting the gastrointestinal tract (15,16).…”

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confidence: 99%

Bolus vs. continuous feeding: effects on splanchnic and cerebral tissue oxygenation in healthy preterm infants

et al. 2014

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Background: Intermittent and continuous tube feeding modes are commonly used to feed preterm infants. However, there is no clear evidence regarding which method is better tolerated. We investigated the differences between bolus and continuous feeding in terms of cerebral and splanchnic oxygenation in healthy preterm infants. Methods: Thirty preterm infants underwent a simultaneous 6-h near-infrared-spectroscopy monitoring of cerebral and splanchnic oxygenation, during which they were fed twice through an orogastric tube: one meal was given as a 10-min bolus, and the other was given continuously over a period of 3 h. Oxygenation trends over time were evaluated and compared between bolus and continuous feeding modes. results: Cerebral oxygenation did not change over time and did not differ between the two feeding techniques. Splanchnic oxygenation changed significantly over time and differed between the two feeding techniques, with a significant increase after bolus feeding and a remarkable reduction during continuous feeding. conclusion: Bolus and continuous feeding modes influence splanchnic oxygenation in healthy preterm infants differently. Further studies are needed to investigate possible underlying mechanisms and potential effects on feeding tolerance.n eonatal care has substantially improved over the past decades, leading to a significant increase in the survival rate of very preterm infants (1). Enteral nutrition is essential for the development of the gastrointestinal tract in the preterm population because it improves intestinal motor activity (2), enhances the release of gastrointestinal hormones with trophic effects (3), and ameliorates feeding tolerance (4). However, very preterm infants are unable to coordinate sucking, swallowing, and breathing (5); thus, they are usually fed via an intragastric tube, continuously or through intermittent boluses (6). Differences between continuous and bolus tube feeding in terms of weight gain, days to full enteral feeding achievement, feeding tolerance, and effect on necrotizing enterocolitis have been largely investigated. Currently, however, there is no clear evidence regarding the method that is better tolerated (7). The effect of the two feeding techniques on cerebral and splanchnic oxygenation has not been extensively investigated. Regional tissue oxygenation results from a dynamic balance between oxygen supply and consumption; thus, a reduction in this parameter might reflect an impairment of systemic oxygen saturation (e.g., due to the occurrence of apneic episodes (8)), a decreased cardiac output leading to a reduction of peripheral perfusion (9), a hemodynamic variation within the examined tissue (e.g., regional vasoconstriction/vasodilatation), or a higher oxygen consumption required to satisfy the metabolic demand (10).Near-infrared spectroscopy (NIRS) is a noninvasive technique based on the near-infrared light absorption spectra of cytochromes, which provides a continuous monitoring of regional tissue oxygenation by measuring the levels of oxygenated a...

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“…Usually, infants deteriorate fast after they are diagnosed with NEC [2], making early prediction of great importance. Many biomarkers have been investigated, but we still lack early signals with high reliability and validity for the detection of the early onset of NEC [3]. …”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis of NEC is commonly based on Bell's criteria [2], but many of the criteria are not NEC specific or evident during the early onset of NEC [3]. Several biochemical biomarkers have been proposed [4], but the need for repeated collecting of blood, urine and/or stool samples has prevented their implementation.…”

Section: Introductionmentioning

confidence: 99%

Physical Activity and Gastric Residuals as Biomarkers for Region-Specific NEC Lesions in Preterm Neonates

Cao

Andersen²,

Li³

et al. 2016

Neonatology

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Background: Necrotizing enterocolitis (NEC) is a serious feeding-related inflammatory gut disease with high mortality. Early clinical markers of NEC are of great importance for optimizing preventive interventions. Objective: Using preterm pigs as models, we hypothesized that an early postnatal onset of NEC can be predicted by decreased physical activity during the first few days after birth. Methods: Cesarean-delivered preterm pigs were fed parenteral nutrition and increasing amounts of formula for 5 days after birth (n = 120). Their physical activity was quantified by a continuous camera surveillance system and they were evaluated twice daily for clinical signs of apathy, discoloration, respiratory distress, abdominal distension and diarrhea. The volume of gastric residuals and the presence of macroscopic NEC-like lesions in the stomach, intestine and colon were recorded at euthanasia on day 5. Results: Half of the pigs (48%) showed clear NEC-like lesions on day 5, and these individuals had more adverse clinical symptoms from day 3 but decreased physical activity already from day 2 relative to the unaffected pigs (both p < 0.05). Only animals with NEC lesions in the small intestine had lower physical activity on days 2 and 3, and the increased volume of gastric residuals was specifically related to colon lesions (both p < 0.05). Conclusions: Decreased physical activity precedes the clinical symptoms of NEC in the small intestine of preterm pigs, and increased gastric residuals predict NEC lesions in the colon. Physical activity and gastric residuals may function as clinical biomarkers for region-specific NEC lesions in preterm neonates.

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Monitoring technologies in the neonatal intensive care unit: implications for the detection of necrotizing enterocolitis

Cited by 34 publications

References 47 publications

Calprotectin levels in necrotizing enterocolitis: a systematic review of the literature

Calprotectin levels in necrotizing enterocolitis: a systematic review of the literature

Bolus vs. continuous feeding: effects on splanchnic and cerebral tissue oxygenation in healthy preterm infants

Physical Activity and Gastric Residuals as Biomarkers for Region-Specific NEC Lesions in Preterm Neonates

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