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Title: Near-infrared spectroscopy measurement of abdominal tissue oxygenation is a useful indicator of intestinal blood flow and necrotizing enterocolitis in premature piglets

item GAY, ANDRE - Baylor College Of Medicine
item LAZAR, DAVID - Baylor College Of Medicine
item STOLL, BARBARA - Children'S Nutrition Research Center (CNRC)
item NAIK-MATHURIA, BINDI - Baylor College Of Medicine
item MUSHIN, OREN - Baylor College Of Medicine
item RODRIGUEZ, MANUEL - Baylor College Of Medicine
item Burrin, Douglas - Doug
item OLUTOYE, OLUYINKA - Baylor College Of Medicine

Submitted to: Journal of Pediatric Surgery
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/26/2011
Publication Date: 6/1/2011
Citation: Gay, A.N., Lazar, D.A., Stoll, B., Naik-Mathuria, B., Mushin, O.P., Rodriguez, M.A., Burrin, D.G., Olutoye, O.O. 2011. Near-infrared spectroscopy measurement of abdominal tissue oxygenation is a useful indicator of intestinal blood flow and necrotizing enterocolitis in premature piglets. Journal of Pediatric Surgery. 46(6):1034-1040.

Interpretive Summary: A significant component of the health care costs in the United States is associated with the care of infants born preterm. A major gut disease in these infants is necrotizing enterocolitis (NEC); and a half million preterm infants are born annually with an increased risk of developing NEC. An important factor that may cause NEC is a drop in intestinal blood flow that reduces the amount of oxygen needed for tissues to function. The aim of this study was to test whether a simple, non-invasive monitor (near-infrared spectroscopy, NIRS) could be used to detect changes in adnominal oxygen status and if this correlated with intestinal blood flow in healthy premature piglets, and those experiencing NEC. We found that the adnominal NIRS measurements were abnormally reduced soon after birth in piglets that developed NEC. We also found the changes in adnominal NIRS measurements were directly proportional to changes in intestinal blood flow in piglets under normal and stimulated conditions. These results are promising and suggest that abdominal NIRS may be a simply, non-invasive tool to monitor intestinal blood flow and identify premature infants that may be at risk for NEC.

Technical Abstract: A major objective of necrotizing enterocolitis (NEC)research is to devise a noninvasive method of early detection. We hypothesized that abdominal near-infrared spectroscopy (A-NIRS) readings will identify impending NEC in a large animal model. Piglets were prematurely delivered and received parenteral nutrition followed by enteral feedings. Serial A-NIRS readings were obtained for 5 days, and animals were monitored for NEC. Separately, A-NIRS readings were obtained in healthy piglets to validate the correlation of A-NIRS with splanchnic oxygen delivery. Of 29 piglets, 3 developed NEC. Eleven piglets without NEC died prematurely. Fifteen piglets remained healthy, had normal histologic assessment of their intestines, and served as controls. Abdominal near-infrared spectroscopy readings within 12 hours of birth were significantly lower in animals that developed NEC compared with healthy littermates (4 percent vs 33 percent, P = .02). For all time-points measured, A-NIRS readings were significantly lower in the NEC group compared with controls (21 percent vs 55 percent, P < .001). Abdominal near-infrared spectroscopy readings correlated with both decreased pulse oximetry readings during apneic episodes (r = 0.96) and increased superior mesenteric artery flow in response to glucagon-like peptide 2 (r = 0.67). Abdominal near-infrared spectroscopy is capable of detecting alterations in intestinal oxygenation and perfusion in neonatal piglets and may allow early detection of neonates at risk for NEC.