Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Division of Pediatric Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Pediatr Res. 2021 Jul;90(1):148-155. doi: 10.1038/s41390-020-01186-8. Epub 2020 Oct 8.
We aimed to investigate whether splanchnic tissue oxygen saturation (rSO) measured by near-infrared spectroscopy (NIRS) could contribute to the early diagnosis of necrotizing enterocolitis (NEC).
We retrospectively included infants with suspected NEC, gestational age <32 weeks and/or birth weight <1200 g in the first 3 weeks after birth. We calculated mean rSO, cerebral tissue oxygen saturation (rSO), variability of rSO (coefficients of variation [rCoVAR] = SD/mean), and splanchnic-cerebral oxygenation ratio ([SCOR] = rSO/rSO) in the period around the abdominal radiograph to confirm or reject NEC.
Of the 75 infants, 21 (28%) had NEC (Bell's stage ≥2). Characteristics of infants with and without NEC differed only on mechanical ventilation and nil-per-os status. RSO tended to be higher and rSO lower in infants with NEC. RCoVAR (median [range]) was lower (0.11 [0.03-0.34]) vs. 0.20 [0.01-0.52], P = 0.002) and SCOR higher (0.64 [0.37-1.36]) vs. 0.47 [0.16-1.09], P = 0.004) in NEC infants. Adjusted for postnatal age, mechanical ventilation, and nil-per-os status, a 0.1 higher rCoVAR decreased the likelihood of NEC diagnosis with likelihood ratio (LR) 0.38 (95% CI 0.18-0.78) and a 0.1 higher SCOR increased it with LR 1.28 (1.02-1.61).
Using NIRS, high SCOR may confirm NEC and high variability of rSO may rule out NEC, when suspicion arises.
Near-infrared spectroscopy may contribute to the diagnosis of necrotizing enterocolitis. When clinical signs are present a high splanchnic-cerebral oxygenation may indicate necrotizing enterocolitis. A low splanchnic-cerebral oxygenation ratio and high variability of splanchnic tissue oxygen saturation may rule out necrotizing enterocolitis. Whether a bedside real-time availability of the splanchnic-cerebral oxygenation ratio and variability of splanchnic tissue oxygen saturation improves NEC diagnosis needs to be further investigated.
本研究旨在探讨近红外光谱（NIRS）测量的内脏组织氧饱和度（rSO）是否有助于早期诊断坏死性小肠结肠炎（NEC）。
我们回顾性纳入了胎龄<32 周且/或出生体重<1200g 的出生后 3 周内疑似 NEC 的婴儿。我们计算了腹部 X 光片前后的 rSO、脑氧饱和度（rSO）、rSO 变异性（变异系数[rCoVAR]=SD/mean）和内脏-脑氧合比（[SCOR]=rSO/rSO），以确认或排除 NEC。
75 例婴儿中，21 例（28%）发生 NEC（Bell 分期≥2 期）。有 NEC 和无 NEC 的婴儿的特征仅在机械通气和禁食状态上存在差异。NEC 婴儿的 rSO 趋于较高，rSO 较低。rCoVAR（中位数[范围]）较低（0.11[0.03-0.34]）vs. 0.20[0.01-0.52]，P=0.002），SCOR 较高（0.64[0.37-1.36]）vs. 0.47[0.16-1.09]，P=0.004）。调整出生后年龄、机械通气和禁食状态后，rCoVAR 每增加 0.1，NEC 诊断的可能性比（LR）降低 0.38（95%CI 0.18-0.78），SCOR 每增加 0.1，可能性比（LR）增加 1.28（1.02-1.61）。
当怀疑 NEC 时，使用 NIRS，高 SCOR 可能有助于 NEC 的确诊，高 rSO 变异性可能有助于排除 NEC。
近红外光谱可能有助于坏死性小肠结肠炎的诊断。当出现临床症状时，较高的内脏-脑氧合可能提示坏死性小肠结肠炎。较低的内脏-脑氧合比值和较高的内脏组织氧饱和度变异性可能排除坏死性小肠结肠炎。床边实时提供内脏-脑氧合比值和内脏组织氧饱和度变异性是否能改善 NEC 诊断，还需要进一步研究。
