Schat Trijntje E, Schurink Maarten, van der Laan Michelle E, Hulscher Jan B F, Hulzebos Christian V, Bos Arend F, Kooi Elisabeth M W
University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, Groningen, the Netherlands.
University of Groningen, University Medical Center Groningen, Department of Surgery, Division of Pediatric Surgery, Groningen, the Netherlands.
PLoS One. 2016 May 16;11(5):e0154710. doi: 10.1371/journal.pone.0154710. eCollection 2016.
To investigate whether cerebral, liver, and infraumbilical regional tissue oxygen saturation (rSO2) and fractional tissue oxygen extraction (FTOE) could be used to diagnose necrotizing enterocolitis (NEC) and complicated NEC (Bell's stage 3B or death) during its early stages.
A prospective observational cohort study of preterm infants with suspected or diagnosed NEC. We compared the mean eight-hour cerebral, liver, and infraumbilical rSO2 and FTOE values of infants with no NEC and definite NEC and of infants with uncomplicated and complicated NEC in the first forty-eight hours after onset of symptoms, suspicious for NEC. Furthermore, we determined cut-off values by generating receiver operating characteristics curves in case of significant differences in the first eight-hour mean values of rSO2 between infants with no NEC and definite NEC and between infants with uncomplicated and complicated NEC.
We included 33 patients: 13 no NEC, 10 with uncomplicated NEC, and 10 with complicated NEC. We found no significant differences in the first twenty-four hours after onset of symptoms in rSO2 and FTOE between infants with no NEC and definite NEC. In preterm infants with complicated NEC, we observed significantly lower cerebral, liver, and infraumbilical rSO2 and higher FTOE within twenty-four hours after onset of symptoms compared with infants with uncomplicated NEC. A continuous cerebral rSO2 ≤ 71% and liver rSO2 ≤ 59% in the first eight hours after onset of symptoms predicted the onset of complicated NEC with a sensitivity of 1.0 and specificity of 0.8, and a sensitivity of 1.0 and specificity of 1.0, respectively.
By measuring the cerebral and splanchnic oxygenation it is possible to differentiate complicated NEC from uncomplicated NEC. In our sample, NIRS monitoring did not proof useful for distinguishing between definite NEC and no NEC in preterm infants with clinical signs suspicious of NEC.
探讨脑、肝及脐下区域组织氧饱和度（rSO2）和组织氧摄取分数（FTOE）能否用于在坏死性小肠结肠炎（NEC）及其并发症（Bell分期3B期或死亡）的早期阶段进行诊断。
对疑似或确诊NEC的早产儿进行一项前瞻性观察队列研究。我们比较了无NEC和确诊NEC的婴儿以及症状发作（怀疑为NEC）后48小时内无并发症和有并发症NEC的婴儿的平均8小时脑、肝及脐下rSO2和FTOE值。此外，在无NEC和确诊NEC的婴儿以及无并发症和有并发症NEC的婴儿之间，若rSO2的前8小时平均值存在显著差异，我们通过绘制受试者工作特征曲线来确定临界值。
我们纳入了33例患者：13例无NEC，10例无并发症NEC，10例有并发症NEC。我们发现，在症状发作后的前24小时内，无NEC和确诊NEC的婴儿之间rSO2和FTOE无显著差异。在有并发症NEC的早产儿中，与无并发症NEC的婴儿相比，我们观察到症状发作后24小时内脑、肝及脐下rSO2显著降低，FTOE升高。症状发作后前8小时持续脑rSO2≤71%和肝rSO2≤59%预测有并发症NEC的发作，敏感性分别为1.0和特异性为0.8，以及敏感性为1.0和特异性为1.0。
通过测量脑和内脏氧合，可以区分有并发症NEC和无并发症NEC。在我们的样本中，近红外光谱监测对于鉴别有临床体征怀疑NEC的早产儿的确诊NEC和无NEC并无帮助。
