Splanchnic Near-Infrared Spectroscopy and Risk of Necrotizing Enterocolitis After Neonatal Heart Surgery

Abstract

Infants with critical congenital heart disease, especially patients with a single-ventricle (SV) physiology, are at increased risk for the development of necrotizing enterocolitis (NEC). Decreased splanchnic oxygen delivery may contribute to the development of NEC and may be detected by regional oximetry (rSO2) via splanchnic near-infrared spectroscopy (NIRS). This prospective study enrolled 64 neonates undergoing biventricular (BV) repair or SV palliation for CHD and monitored postoperative splanchnic rSO2 before and during initiation of enteral feedings to determine whether changes in rSO2 are associated with risk of NEC. Suspected or proven NEC was observed in 32 % (11/34) of the SV subjects and 0 % (0/30) of the BV subjects (p = 0.001). Compared with the BV subjects, the SV palliated subjects had significantly lower splanchnic rSO2 before and during initiation of enteral feedings, but the groups showed no difference after correction for lower pulse oximetry (SpO2) in the SV group. The clinical parameters were similar among the SV subjects with and without NEC except for cardiopulmonary bypass times, which were longer for the patients who experienced NEC (126 vs 85 min; p = 0.03). No difference was observed in splanchnic rSO2 or in the SpO2–rSO2 difference between the SV subjects with and without NEC. Compared with the patients who had suspected or no NEC, the subjects with proven NEC had a lower average splanchnic rSO2 (32.6 vs 47.0 %; p = 0.05), more time with rSO2 less than 30 % (48.8 vs 6.7 %; p = 0.04) at one-fourth-volume feeds, and more time with SpO2–rSO2 exceeding 50 % (33.3 vs 0 %; p = 0.03) before feeds were initiated. These data suggest that splanchnic NIRS may be a useful tool for assessing risk of NEC, especially in patients with an SV physiology.

The association of congenital heart disease with necrotizing enterocolitis in preterm infants: a birth cohort study

“…Dewitt et al reported that lower regional splanchnic oxygen saturations using near infrared spectroscopy were associated with an increased risk for the development of NEC in patients undergoing single ventricle surgical repair. 16 Castillo et al reported success in reducing the incidence of NEC in infants with hypoplastic left heart with the introduction of a feeding protocol and Dili et al reported reduced risk for the development of NEC in infants with cyanotic congenital heart disease with the use of probiotics. 17,18 In this cohort, severe CHD but not mild CHD was independently associated with an increased risk for NEC.…”

The use of cerebral and somatic regional tissue oxygen saturation in monitoring of critically ill children who were admitted to the pediatric emergency department: A prospective descriptive study

“…DeWitt ve ark. (12) tarafından yapılan çalışmada ise, özellikle tek ventrikül fizyolojisinde olan yenidoğanların postoperatif takiplerinde düşük SrSO 2 değerlerinin nekrotizan enterokolit gelişimi ile ilişikli olduğu vurgulanmıştır.…”

Current research in necrotizing enterocolitis

“…Near infra-red spectroscopy (NIRS) has also been investigated by researchers who believe it may be useful at predicting risk of NEC [75] [76], distinguishing infants with NEC from those without and for the identification of infants with advanced NEC. NIRS measures oxygenation at the tissue level using probes placed on the skin and is limited by a short depth of tissue penetration, typically (<1cm).…”

“…NIRS does not have the ability however to determine oxygenation in the entire intestine. Despite this, differences have been detected in splanchnic tissue oxygenation values using NIRS between preterm infants who subsequently developed NEC and those who did not [75,76] [77]. Whether NIRS can be used with clinical benefit to prevent NEC with infants with NEC remains to be seen.…”