Mesenteric near-infrared spectroscopy and risk of gastrointestinal complications in infants undergoing surgery for congenital heart disease.
We hypothesised that lower mesenteric near-infrared spectroscopy values would be associated with a greater incidence of gastrointestinal complications in children weighing <10 kg who were recovering from cardiac surgery. We evaluated mesenteric near-infrared spectroscopy, central venous oxygen saturation, and arterial blood gases for 48 hours post-operatively. Enteral feeding intake, gastrointestinal complications, and markers of organ dysfunction were monitored for 7 days. A total of 50 children, with median age of 16.7 (3.2-31.6) weeks, were studied. On admission, the average mesenteric near-infrared spectroscopy value was 71±18%, and the systemic oxygen saturation was 93±7.5%. Lower admission mesenteric near-infrared spectroscopy correlated with longer time to establish enteral feeds (r=-0.58, p<0.01) and shorter duration of feeds at 7 days (r=0.48, p<0.01). Children with gastrointestinal complications had significantly lower admission mesenteric near-infrared spectroscopy (58±18% versus 73±17%, p=0.01) and higher mesenteric arteriovenous difference of oxygen at admission [39 (23-47) % versus 19 (4-27) %, p=0.02]. Based on multiple logistic regression, admission mesenteric near-infrared spectroscopy was independently associated with gastrointestinal complications (Odds ratio, 0.95; 95% confidence interval, 0.93-0.97; p=0.03). Admission mesenteric near-infrared spectroscopy showed an area under the receiver operating characteristic curve of 0.76 to identify children who developed gastrointestinal complications, with a suggested cut-off value of 72% (78% sensitivity, 68% specificity). In this pilot study, we conclude that admission mesenteric near-infrared spectroscopy is associated with gastrointestinal complications and enteral feeding tolerance in children after cardiac surgery.
1Paediatric Intensive Care Unit,Royal Brompton Hospital,London,United Kingdom.
Ilias
I
Iliopoulos
1Paediatric Intensive Care Unit,Royal Brompton Hospital,London,United Kingdom.
Ricardo G
RG
Branco
1Paediatric Intensive Care Unit,Royal Brompton Hospital,London,United Kingdom.
Nadine
N
Brinkhuis
1Paediatric Intensive Care Unit,Royal Brompton Hospital,London,United Kingdom.
Anke
A
Furck
1Paediatric Intensive Care Unit,Royal Brompton Hospital,London,United Kingdom.
Joan
J
LaRovere
2Cardiac Intensive Care Unit,Cincinnati Children's Hospital Medical Center,Cincinnati,Ohio,United States of America.
David S
DS
Cooper
1Paediatric Intensive Care Unit,Royal Brompton Hospital,London,United Kingdom.
Nazima
N
Pathan
D005260:Female; D005767:Gastrointestinal Diseases / Q000000981:diagnostic imaging*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008643:Mesentery / Q000000981:diagnostic imaging*; D010865:Pilot Projects; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D018570:Risk Assessment; D019265:Spectroscopy, Near-Infrared
CHD; Near-infrared spectroscopy; cardiac surgery; feeding tolerance; gastrointestinal complication; mesenteric perfusion