Near-infrared spectroscopy as a diagnostic tool for necrotizing enterocolitis in preterm infants

Heide, Martin van der; Hulscher, Jan B F; Bos, Arend F.; Kooi, Elisabeth M. W.

doi:10.1038/s41390-020-01186-8

Cited by 29 publications

(11 citation statements)

References 25 publications

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“…Intestinal injury in preterm infants has previously been reported to be associated with a diminished r s SO 2 variability. [29][30][31]40 Our results are in line with those associations, as the presence of reduced variability co-occurred with higher urinary levels of biomarkers for intestinal cell injury after the RBC transfusion. This indicates that intestinal epithelial injury is reflected by an inadequate splanchnic vasculatory response, possibly due to an inability to adapt to changes in the balance between oxygen supply and demand.…”

Section: Discussionsupporting

confidence: 87%

“…With NIRS, splanchnic tissue oxygen saturation (r s SO 2 ) can be measured continuously and non-invasively. 27,28 Previously, NIRS measurements have proven its added value in showing a different vasculatory response in infants developing NEC after RBC transfusion, 29 contributing to the diagnosis of NEC, 30,31 predicting complicated NEC, 32 and predicting intestinal recovery after NEC. 33 Decreased variability of r s SO 2 might represent the diminished capacity for splanchnic vascular adaptation by the immature intestines.…”

Section: Introductionmentioning

confidence: 99%

“…33 Decreased variability of r s SO 2 might represent the diminished capacity for splanchnic vascular adaptation by the immature intestines. [29][30][31][32] To increase the knowledge on both the beneficial and harmful short-term effects of an RBC transfusion in preterm infants, and its potential association with intestinal injury, the first aim of this study was to investigate the effect of RBC transfusions on urinary biomarkers for oxidative stress and intestinal cell damage in preterm infants. If there was such an effect, did these biomarkers correlate with each other?…”

Section: Introductionmentioning

confidence: 99%

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The short-term effects of RBC transfusions on intestinal injury in preterm infants

et al. 2022

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BACKGROUND: Anemic preterm infants may require red blood cell (RBC) transfusions to maintain sufficient oxygen supply to vital organs. Transfusion treatment, however, may have adverse intestinal effects. We aimed to investigate the short-term effects of RBC transfusions, hypothesizing to find signs of oxidative stress and intestinal injury, possibly related to levels of splanchnic (re-) oxygenation. METHODS: We prospectively included preterm infants (gestational age < 32 weeks). We measured urinary biomarkers for oxidative stress (8-isoprostane) and intestinal cell injury (intestinal fatty acid-binding protein, I-FABP) shortly before and after RBC transfusion. Splanchnic oxygen saturation (r s SO 2 ) and r s SO 2 variability were assessed simultaneously. RESULTS: Twenty-nine preterm infants received 58 RBC transfusions at various postnatal ages. Six of them developed necrotizing enterocolitis (NEC) after transfusion. Urinary 8-isoprostane and I-FABP increased following RBC transfusion (median 282-606 pg/ml and 4732-6968 pg/ml, p < 0.01), more pronounced in infants who developed NEC. Change in I-FABP correlated with change in 8-isoprostane (rho = 0.623, p < 0.01). Lower r s SO 2 variability, but not higher mean r s SO 2 was associated with higher 8-isoprostane and I-FABP levels after transfusion. CONCLUSIONS: Preterm RBC transfusions are associated with concomitant signs of oxidative stress and intestinal injury, parallel with lower variability in splanchnic oxygenation. This may represent the early pathogenetic process of transfusion-associated NEC.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The short-term effects of RBC transfusions on intestinal injury in preterm infants

et al. 2022

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“…[30][31][32] Similarly, lower baseline variability of r s SO 2 and reduced r s SO 2 -variability after RBC transfusion have been associated with NEC. 20,33,34 Although the mechanisms leading to intestinal injury following anemia and RBC transfusion may differ from those following hypoxia and reoxygenation, we further speculate that reduced r s SO 2 -variability may be indicative of microvascular injury, leading to impaired microvascular blood flow and increased microvascular permeability as seen in intestinal ischemiareperfusion. 35 By definition, r s CoVar is dependent on mean r s SO 2 ; thus, higher mean r s SO 2 is accompanied by lower r s CoVar.…”

Section: Discussionmentioning

confidence: 84%

Splanchnic oxygen saturation during reoxygenation with 21% or 100% O2 in newborn piglets

et al. 2021

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BACKGROUND: Increasing evidence recognizes the harm of excess oxygen to lungs, eyes, and brain of preterm infants, but not yet to the intestine. We assessed changes in splanchnic oxygenation during reoxygenation with 21% compared to 100% O 2 in a newborn piglet model of perinatal asphyxia. METHODS: We randomized 25 piglets to control or intervention. Intervention groups underwent global hypoxia until acidosis and hypotension occurred. Piglets were reoxygenated for 30 min with 21% or 100% O 2 and observed for 9 h. We continuously measured regional splanchnic oxygen saturation (r s SO 2 ) using near-infrared spectroscopy (NIRS). We calculated mean r s SO 2 and r s CoVar (as SD/mean). We measured PaO 2 and SaO 2 , sampled from the right carotid artery. RESULTS: Reoxygenation after global hypoxia restored r s SO 2 . Reoxygenation with 100% O 2 increased r s SO 2 to values significantly higher than baseline. In intervention groups, r s CoVar decreased during observation compared to baseline. We found a correlation between r s SO 2 and PaO 2 (r = 0.420, P < 0.001) and between r s SO 2 and SaO 2 (r = 0.648, P < 0.001) in pooled data from the entire experiment. CONCLUSION: Reoxygenation after global hypoxia improves splanchnic oxygenation, but is associated with reduced variability of r s SO 2 . Reoxygenation with 100% O 2 exposes the intestine to hyperoxia. Splanchnic NIRS is able to detect intestinal hypoxia and hyperoxia.

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“…Due to neonatal immaturity and developing gastrointestinal systems, preterm infants are more prone to feeding intolerance and necrotizing enterocolitis (NEC). Near-infrared spectroscopy ( 9 ) and intestine ultrasonography ( 10 ) are two non-invasive methods that have been examined for blood flow and motility to observe intestinal movement and aid in the diagnosis of NEC in preterm infants. However, the necessity for expert interpretation and the incapacity of real-time and long-term monitoring restrict their extensive application.…”

Section: Introductionmentioning

confidence: 99%

Feasibility and basic acoustic characteristics of intelligent long-term bowel sound analysis in term neonates

Zhou¹,

Lü²,

Chen³

et al. 2022

Front. Pediatr.

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ObjectiveBowel dysfunction continues to be a serious issue in neonates. Traditional auscultation of bowel sounds as a diagnostic tool in neonatal gastrointestinal problems is limited by skill and inability to document and reassess. Consequently, in order to objectively and noninvasively examine the viability of continuous assessment of bowel sounds, we utilized an acoustic recording and analysis system to capture bowel sounds and extract acoustic features in term neonates.MethodsFrom May 1, 2020 to September 30, 2020, 82 neonates who were hospitalized because of hyperbilirubinemia were included. For 20 h, a convolutional neural network-based acoustic recorder that offers real-time, wireless, continuous auscultation was employed to track the bowel sounds of these neonates.Results(1) Usable data on five acoustic parameters of bowel sound was recorded for 68 neonates, and the median values were as follows: The rate was 25.80 times/min [interquartile range (IQR): 15.63–36.20]; the duration was 8.00 s/min (IQR: 4.2–13.20); the amplitude was 0.46 (IQR: 0.27–0.68); the frequency was 944.05 Hz (IQR: 848.78–1,034.90); and the interval time was 2.12 s (IQR: 1.3–3.5). (2) In comparison to the parameters of the bowel sounds recorded from the right lower abdomen in 68 infants, the acoustic parameters of the 10 out of 68 infants from chest controls and blank controls were considerably different. (3) The 50%–75% breast milk intake group had the highest rate, the longest duration, and the highest amplitude of bowel sounds, while the >75% breast milk intake group had the highest frequency of bowel sounds. (4) Compared with neonates without hyperbilirubinemia, there was no significant difference in the five parameters of bowel sounds in hyperbilirubinemia infants; nor was there a significant effect of phototherapy and non-phototherapy status on the parameters of bowel sounds during bowel sound monitoring in hyperbilirubinemia patients. (5) A mild transient skin rash appeared on the skin of three infants. No other adverse events occurred.ConclusionThe acoustic recording and analysis system appears useful for monitoring bowel sounds using a continuous, invasive, and real-time approach. Neonatal bowel sounds are affected by various feeding types rather than hyperbilirubinemia and phototherapy. Potential influencing factors and the significance of their application in neonatal intestinal-related disorders require further research.

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Near-infrared spectroscopy as a diagnostic tool for necrotizing enterocolitis in preterm infants

Cited by 29 publications

References 25 publications

The short-term effects of RBC transfusions on intestinal injury in preterm infants

The short-term effects of RBC transfusions on intestinal injury in preterm infants

Splanchnic oxygen saturation during reoxygenation with 21% or 100% O2 in newborn piglets

Feasibility and basic acoustic characteristics of intelligent long-term bowel sound analysis in term neonates

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