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Title: Abdominal near-infrared spectroscopy measurements are lower in preterm infants at risk for necrotizing enterocolitis

Author
item PATEL, ASHISH - Baylor College Of Medicine
item LAZAR, DAVID - Baylor College Of Medicine
item Burrin, Douglas - Doug
item SMITH, E. O'BRIAN - Children'S Nutrition Research Center (CNRC)
item MAGLIARO, THOMAS - Baylor College Of Medicine
item STARK, ANN - Baylor College Of Medicine
item BRANDT, MARY - Baylor College Of Medicine
item ZAMORA, IRVING - Baylor College Of Medicine
item SHEIKH, FARIHA - Baylor College Of Medicine
item AKINKUOTU, ADESOLA - Baylor College Of Medicine
item OLUTOYE, OLUYINKA - Baylor College Of Medicine

Submitted to: Pediatric Critical Care Medicine
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/25/2014
Publication Date: 10/1/2014
Citation: Patel, A.K., Lazar, D.A., Burrin, D.G., Smith, E., Magliaro, T.J., Stark, A.R., Brandt, M.L., Zamora, I.J., Sheikh, F., Akinkuotu, A.C., Olutoye, O.O. 2014. Abdominal near-infrared spectroscopy measurements are lower in preterm infants at risk for necrotizing enterocolitis. Pediatric Critical Care Medicine. 15(8):735-741.

Interpretive Summary: Premature infants are at increased risk for an intestinal disease called necrotizing enterocolitis (NEC). Only a small percentage of infants develop NEC, but it has devastating effects on the health, development and can be fatal. One factor that has been linked to NEC is reduced blood flow to the developing premature intestine. Near-infrared spectroscopy (NIRS) is a non-invasive device that measures oxygen content (StO[2]) in living tissue and thus can be used as a marker of intestinal blood flow in infants. The aim of the current study was to use NIRS to establish normal StO[2] values measured on the belly or abdomen in preterm infants and test whether these values are reduced in infants who develop NEC. We found in 78 normal, healthy babies in the first week of life that the StO[2] was 77%. More importantly, we found that those babies later developed NEC, and had lower values suggesting lower intestinal blood flow. These findings provide further evidence that NIRS can be used as an effective, non-invasive monitoring tool to identify infants at risk for NEC.

Technical Abstract: Near-infrared spectroscopy is a noninvasive method of measuring local tissue oxygenation (StO[2]). Abdominal StO[2] measurements in preterm piglets are directly correlated with changes in intestinal blood flow and markedly reduced by necrotizing enterocolitis. The objectives of this study were to use near-infrared spectroscopy to establish normal values for abdominal StO[2] in preterm infants and test whether these values are reduced in infants who develop necrotizing enterocolitis. We conducted a 2-year prospective cohort study where we prospectively measured abdominal StO[2] in preterm infants, to establish reference values for preterm infants, and compared the near-infrared spectroscopy values with preterm infants in the cohort that developed necrotizing enterocolitis. We used two neonatal ICUs: one at Texas Children's Hospital and the other at Ben Taub General Hospital in Houston, TX. We enrolled 100 preterm infants (< 32 weeks' gestation and < 1,500 g birth weight) between January 2007 and November 2008. There were no interventions. Eight neonates with incomplete data were excluded. Mean abdominal StO[2] in normal preterm infants (n = 78) during the first week of life was significantly higher than in those who later developed necrotizing enterocolitis (n = 14) (77.3% +/- 14.4% vs 70.7% +/- 19.1%, respectively, p = 0.002). An StO[2] less than or equal to 56% identified preterm infants progressing to necrotizing enterocolitis with 86% sensitivity, 64% specificity, 96% negative predictive value, and 30% positive predictive value. Using logistic regression, StO[2] less than or equal to 56% was independently associated with a significantly increased risk of necrotizing enterocolitis (odds ratio, 14.1; p = 0.01). Furthermore, infants with necrotizing enterocolitis demonstrated significantly more variation in StO[2] both during and after feeding in the first 2 weeks of life. In conclusion, this study establishes normal values for abdominal StO[2] in preterm infants and demonstrates decreased values and increased variability in those with necrotizing enterocolitis. Abdominal near-infrared spectroscopy monitoring of preterm infants may be a useful tool for early diagnosis and guiding treatment of necrotizing enterocolitis.