Measurement of gut oxygenation in the neonatal population using near-infrared spectroscopy: a clinical tool?

Seager, Emilie; Longley, Catherine; Aladangady, Narendra; Banerjee, Jayanta

doi:10.1136/archdischild-2018-316750

Cited by 15 publications

(16 citation statements)

References 52 publications

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“…With regard to applicability in clinical practice, it is difficult to know how far we can extrapolate findings from physiological studies such as this. Splanchnic NIRS measurements have not been validated in the same way as cerebral NIRS measurements [20] and this fundamentally limits what we can infer clinically from these results. The study was limited by a low background incidence of NEC, with no eligible infant developing NEC during the study period or at any stage during hospitalisation.…”

Section: Discussionmentioning

confidence: 99%

FEEding DURing red cell transfusion (FEEDUR RCT): a multi-arm randomised controlled trial

et al. 2020

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Background: Necrotising Enterocolitis (NEC) is a devastating neonatal disease. A temporal association between red cell transfusion and NEC has been recognized and there have been concerns about the effects of feeding during transfusion. We aimed to assess the effect of different enteral feeding regimens on splanchnic oxygenation in preterm infants receiving red cell transfusions. Methods: This was an open, multi-arm, parallel-group, randomised controlled trial conducted in a single centre in Australia. We compared three different enteral feeding regimes during a single red cell transfusion in preterm infants < 35 weeks gestational age at birth. Infants were randomised to either: (1) Withholding enteral feeds for 12 h from the start of transfusion or; (2) Continuing enteral feeds or; (3) Restriction of enteral feed volume to 120 ml/kg/ day (maximum 20 kcal/30 ml) for 12 h. The primary outcome was mean splanchnic-cerebral oxygenation ratio (SCOR) and mean splanchnic fractional oxygen extraction (FOE) before (1 h prior), during (1 h into transfusion) and after (end of transfusion; 12 and 24 h post) transfusion. Results: There were 60 transfusion episodes (20 transfusion episodes in each group) included in the analysis. 41 infants with a median gestational age at birth of 27 weeks (range 23-32 weeks) were enrolled. The median postnatal age was 43 days (range 19-94 days) and the median pre-transfusion haematocrit was 0.27 (range 0.22-0.32). All three groups were similar at baseline. There were no differences in mean SCOR and mean splanchnic FOE at any of the pre-specified time points. There were also no differences in clinical outcomes. There were no episodes of NEC in any infant. Across all groups the mean SCOR increased from the start to the end of each transfusion (0.97 [CI95% 0.96-0.98] vs 1.00 [CI95% 0.99-1.01]; p = 0.04) and the mean FOE decreased from the start to the end of each transfusion (0.22 [CI95% 0.21-0.23] vs 0.17 [CI95% 0.16-0.18]; p < 0.001). Conclusions: There were no differences in splanchnic oxygenation when enteral feeds were either withheld, continued or restricted during a transfusion. However, the successful conduct of this study supports the feasibility of a large trial powered to assess clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

FEEding DURing red cell transfusion (FEEDUR RCT): a multi-arm randomised controlled trial

et al. 2020

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“…First, our review describes the mechanistic strategies available to neonatal and mature intestine to maintain adequate oxygenation, but does not include the contribution of these strategies during external influences that may alter intestinal oxygen supply or demand, e.g., anemia and enteral feeding. Nevertheless, our speculations on implications of these external influences on intestinal oxygenation are supported by recent reviews in both animal models and preterm neonates (18,19,44). Second, we purposely did not take into account factors that may influence the maturation processes described.…”

Section: Interpretation and Discussionmentioning

confidence: 72%

“…Near-infrared spectroscopy (NIRS) is a non-invasive, bedside technique used to continuously monitor regional oxygen saturation (rSO 2 ) (17). Previous studies have reported promising results for splanchnic rSO 2 (r s SO 2 )monitoring for detecting hemodynamic changes that accompany physiologic and pathophysiologic conditions (18,19). Currently, the use of splanchnic NIRS remains mostly limited to research settings.…”

Section: Introductionmentioning

confidence: 99%

Maturation of Intestinal Oxygenation: A Review of Mechanisms and Clinical Implications for Preterm Neonates

et al. 2020

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Nutrient requirements of preterm neonates may be substantial, to support growth and maturation processes in the presence of challenging post-natal circumstances. This may be accompanied by substantial intestinal oxygen requirements. Preterm neonates may not be able to meet these oxygen requirements, due to a developmental delay in intestinal oxygenation regulation mechanisms. This review summarizes the available literature on post-natal maturation of intestinal oxygenation mechanisms and translates these changes into clinical observations and potential implications for preterm neonates. The different mechanisms that may be involved in regulation of intestinal oxygenation, regardless of post-natal age, are first discussed. The contribution of these mechanisms to intestinal oxygenation regulation is then evaluated in newborn and mature intestine. Finally, the course of clinical observations is used to translate these findings to potential implications for preterm neonates.

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“…[6][7][8] Preliminary studies have suggested that NIRS profiles may differ in terms of mean mesenteric r-SO 2 values and variations in the weeks or days preceding the occurrence of NEC. [9][10][11][12] However, these studies and other works using various NIRS-derived tissue oxygenation indexes 13,14 have not considered the potential role of NIRS in the early diagnosis of NEC in a newborn with gastrointestinal signs pointing to this disease, such as feeding intolerance or bloody stools. The objective of this study was to assess the ability of NIRS to diagnose NEC in neonates with bloody stools and/or abdominal distension.…”

mentioning

confidence: 99%

Near-Infrared Spectroscopy: A Tool for Diagnosing Necrotizing Enterocolitis at Onset of Symptoms in Preterm Neonates with Acute Gastrointestinal Symptoms?

Bouhellec

Prodhomme²,

Mura

et al. 2020

Am J Perinatol

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Objective In premature neonates, bloody stools and/or abdominal distension with feeding intolerance may be inaugural signs of necrotizing enterocolitis (NEC). We assessed the ability of near-infrared spectroscopy (NIRS) to distinguish those neonates with NEC soon after the occurrence of these symptoms. Study Design We prospectively collected NIRS measurements of abdominal and cerebral regional tissue oxygen saturation (r-SO2), with values masked by an opaque cover. Two physicians, blinded to the NIRS data, determined whether the gastrointestinal symptoms were related to NEC 10 days after symptom onset. Results Forty-five neonates with mean (standard deviation [SD]) gestational, birth weight and postnatal ages of 31 (3.9) weeks, 1,486 (794) g, and 18 (14) days were enrolled over 30 months. Gastrointestinal symptoms were related to NEC in 23 patients and associated with other causes in 22. Analysis of the 48 hours of monitoring revealed comparable abdominal r-SO2 and splanchnic-cerebral oxygenation ratio (SCOR) in patients with and without NEC (r-SO2: 47.3 [20.4] vs. 50.4 [17.8], p = 0.59, SCOR: 0.64 [0.26] vs. 0.69 [0.24], p = 0.51). Results were unchanged after NIRS analysis in 6-hour periods, and restriction of the analysis to severe NEC (i.e., grade 2 and 3, 57% of the NEC cases). Conclusion In this study, NIRS monitoring was unable to individualize NEC in premature infants with acute gastrointestinal symptoms.

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Measurement of gut oxygenation in the neonatal population using near-infrared spectroscopy: a clinical tool?

Cited by 15 publications

References 52 publications

FEEding DURing red cell transfusion (FEEDUR RCT): a multi-arm randomised controlled trial

FEEding DURing red cell transfusion (FEEDUR RCT): a multi-arm randomised controlled trial

Maturation of Intestinal Oxygenation: A Review of Mechanisms and Clinical Implications for Preterm Neonates

Near-Infrared Spectroscopy: A Tool for Diagnosing Necrotizing Enterocolitis at Onset of Symptoms in Preterm Neonates with Acute Gastrointestinal Symptoms?

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