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Original article
The relation between splanchnic ischaemia and intestinal damage in necrotising enterocolitis
  1. Trijntje E Schat1,
  2. Fardou H Heida2,
  3. Maarten Schurink2,
  4. Michelle E van der Laan1,
  5. Christian V Hulzebos1,
  6. Arend F Bos1,
  7. Elisabeth M W Kooi1,
  8. Jan B F Hulscher2
  1. 1Division of Neonatology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
  2. 2Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  1. Correspondence to Dr Fardou H Heida Division of Pediatric Surgery, Department of Surgery, University Medical Center of Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; f.h.heida{at}umcg.nl

Abstract

Objectives The underlying pathophysiology of necrotising enterocolitis (NEC) remains incompletely understood, particularly the role of intestinal perfusion. We aimed to determine the relation between cerebral and splanchnic fractional tissue oxygen extraction (FTOE), a marker for tissue underperfusion, with intestinal fatty acid-binding protein in plasma (I-FABPp), a marker for intestinal damage, in infants with NEC. Furthermore, we investigated the combined courses of cerebral and splanchnic FTOE values and I-FABPp levels in uncomplicated (conservative treatment) and complicated NEC (surgery or death).

Design This study was part of a prospective observational cohort study.

Patients We included 19 preterm infants with NEC (9 uncomplicated, 10 complicated).

Interventions Using near-infrared spectroscopy, we measured regional cerebral and splanchnic tissue oxygen saturations continuously for 48 h after NEC onset. We measured I-FABPp levels simultaneously.

Main outcome measures We used Spearman correlation tests to calculate correlation coefficients between FTOE values and I-FABPp levels in uncomplicated and complicated NEC.

Results Median (range) gestational age was 28 (25–36) weeks and median (range) birth weight was 1290 (740–2400) g. Cerebral and splanchnic FTOE values correlated strongly with I-FABPp levels (rho between .745 and 0.900; p<0.001–0.037) during the first 16 h after NEC onset. Thereafter, in uncomplicated NEC, splanchnic FTOE values increased while I-FABPp levels decreased concomitantly. In complicated NEC both splanchnic FTOE values and I-FABPp levels decreased.

Conclusions Combining cerebral and splanchnic FTOE values with I-FABPp levels, gives insight in the pathological chain of events resulting in progression or recovery of intestinal ischaemia in NEC.

Trial registration number NTR3239.

  • Necrotizing enterocolitis
  • Intestinal fatty acid-binding protein
  • Near infrared spectroscopy

https://doi.org/10.1136/archdischild-2015-309838

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    Footnotes

    • FHH and TES contributed equally to this manuscript.

    • Contributors TES conceptualised and designed the study, performed the study, drafted the initial manuscript, and approved the final manuscript as submitted. FHH: conceptualised and designed the study, performed the study, drafted the initial manuscript, and approved the final manuscript as submitted. MS conceptualised and designed the study, and approved the final manuscript as submitted. MEvdL contributed to the performance of the study, reviewed and revised the manuscript the manuscript, and approved the final manuscript as submitted. CVH reviewed and revised the manuscript and approved the final manuscript as submitted. AFB: reviewed and revised the manuscript and approved the final manuscript as submitted. EMWK: reviewed and revised the manuscript and approved the final manuscript as submitted. JBFH: supervised the study, reviewed and revised the manuscript and approved the final manuscript as submitted.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval The ethical review board of University Medical Center Groningen.

    • Provenance and peer review Not commissioned; externally peer reviewed.