title: Near-Infrared Spectroscopy to Predict the Course of Necrotizing Enterocolitis.
abstract: 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.
authors.affiliation: University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, Groningen, the Netherlands.
authors.forename: Trijntje E
authors.initials: TE
authors.lastname: Schat
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Surgery, Division of Pediatric Surgery, Groningen, the Netherlands.
authors.forename: Maarten
authors.initials: M
authors.lastname: Schurink
authors.affiliation: University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, Groningen, the Netherlands.
authors.forename: Michelle E
authors.initials: ME
authors.lastname: van der Laan
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Surgery, Division of Pediatric Surgery, Groningen, the Netherlands.
authors.forename: Jan B F
authors.initials: JB
authors.lastname: Hulscher
authors.affiliation: University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, Groningen, the Netherlands.
authors.forename: Christian V
authors.initials: CV
authors.lastname: Hulzebos
authors.affiliation: University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, Groningen, the Netherlands.
authors.forename: Arend F
authors.initials: AF
authors.lastname: Bos
authors.affiliation: University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, Groningen, the Netherlands.
authors.forename: Elisabeth M W
authors.initials: EM
authors.lastname: Kooi
mesh_terms: D018450:Disease Progression; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism / Q000401:mortality; D005260:Female; D006801:Humans; D007223:Infant; D007234:Infant, Premature; D008297:Male; D009928:Organ Specificity; D010100:Oxygen / Q000378:metabolism; D010641:Phenotype; D011446:Prospective Studies; D012372:ROC Curve; D019265:Spectroscopy, Near-Infrared / Q000379:methods*; D013997:Time Factors
chemical_list: D010100:Oxygen