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

Abstract

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.

Role of Near-infrared Spectroscopy in the Diagnosis and Assessment of Necrotizing Enterocolitis

“…A couple of studies have concluded that NIRS could not diagnose NEC after the onset of clinical features. 34 , 52 NIRS can alert and warn neonatologists about the beginning of bowel ischemia; however, it might not differentiate between NEC and other intestinal ischemic conditions during the early phase of disease satisfactorily.…”

“…Two observational studies had reported the inability of NIRS monitoring to differentiate between neonates with and without NEC when it was started shortly after the development of clinical features typical of NEC (bloody stools and abdominal distension). 34 , 52 …”

Biomarkers of gut injury in neonates – where are we in predicting necrotising enterocolitis?

“…In addition, there are newer biomarkers being suggested which might more accurately reflect intestinal injury such as Near Infrared Spectroscopy (NIRS) (112)(113)(114)(115)(116)(117) and USS doppler studies (118) of the splanchnic oxygenation and blood flow respectively. These alternative non-invasive modalities could facilitate earlier detection of the onset of NEC; however, they also have their own limitations.…”

Could Near Infrared Spectroscopy (NIRS) be the new weapon in our fight against Necrotising Enterocolitis?

“…Table 1 summarises the available neonatal studies on the use of NIRS to measure splanchnic oxygenation in neonates (9,(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). Table 2 summarises the literature available specifically for the use of NIRS for predicting or diagnosing NEC (15,27,(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39).…”