2009 Southern Regional Meeting Abstracts

Purpose of Study: Necrotizing entercolitis (NEC) is a significant cause of morbidity and mortality in the neonatal intensive care unit. Decreased perfusion to the intestines may contribute to its pathophysiology, as well as possibly represent that intestinal tissue is necrotic. Near Infrared Spectroscopy (NIRS) is a noninvasive procedure which can measure regional oxygenation by measuring and continuously recording the weighted average of arterial and venous saturations. Our objective was to determine if preterm infants with NEC had significantly different abdominal NIRS values compared to matched controls that did not have NEC but were equally ill.
Methods Used: Prospective analysis of 20 preterm infants (10 infants with Bells stage II or higher NEC, 10 matched controls) who were greater than 1000g and transferred to a referral children’s hospital NICU in Atlanta for possible surgical evaluation. Exclusion criteria were major congenital anomalies including genetic, abdominal wall defects, cardiac anomalies, and infants offered comfort care only. Continuous abdominal NIRS measurements were done for up to 24 hours prior to going to the OR and were compared to cerebral NIRS for internal reference on each patient.
Summary of Results: In the NEC subgroup we found that there was 1) A statistically lower abdominal NIRS value compared to infants with septic shock and no abdominal process, 2) A trend towards matching the worse findings at surgery and the lowest abdominal NIRS values, 3) A real time recording of a perforation due to NEC.
Conclusions: Our study demonstrates the ability of NIRS to differentiate between infants with surgical NEC and infants that have septic shock and a process other than an abdominal insult. Ongoing studies are evaluating if NIRS is a tool that in the NICU may have a role in helping to determine when to operate on infants with NEC, and can it tell us how much bowel rest is sufficient after medical NEC prior to initiating refeeds.