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Low Abdominal NIRS Values and Elevated Plasma Intestinal Fatty Acid-Binding Protein in a Premature Piglet Model of Necrotizing Enterocolitis.

Zamora IJ, Stoll B, Ethun CG, Sheikh F, Yu L, Burrin DG, Brandt ML, Olutoye OO - PLoS ONE (2015)

Bottom Line: NEC piglets demonstrated greater variability from baseline in A-NIRS than healthy piglets (10.1% vs. 6.3%; p=0.04).Mean pI-FABP levels were higher in animals that developed NEC compared to No-NEC piglets (0.66 vs. 0.09 ng/mL;p<0.001).In premature piglets, low A-NIRS in the early neonatal period and increased variability during initial feeds are highly predictive of NEC, which is then confirmed by rising plasma I-FABP levels.

View Article: PubMed Central - PubMed

Affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, United States of America.

ABSTRACT
To identify early markers of necrotizing enterocolitis (NEC), we hypothesized that continuous abdominal near-infrared spectroscopy (A-NIRS) measurement of splanchnic tissue oxygen saturation and intermittent plasma intestinal fatty-acid binding protein (pI-FABP) measured every 6 hours can detect NEC prior to onset of clinical symptoms. Premature piglets received parenteral nutrition for 48-hours after delivery, followed by enteral feeds every three hours until death or euthanasia at 96-hours. Continuous A-NIRS, systemic oxygen saturation (SpO2), and heart rate were measured while monitoring for clinical signs of NEC. Blood samples obtained at 6-hour intervals were used to determine pI-FABP levels by ELISA. Piglets were classified as fulminant-NEC (f-NEC), non-fulminant-NEC (nf-NEC) and No-NEC according to severity of clinical and histologic features. Of 38 piglets, 37% (n=14) developed nf-NEC, 18% (n=7) developed f-NEC and 45% (n=17) had No-NEC. There were significant differences in baseline heart rate (p=0.008), SpO2 (p<0.001) and A-NIRS (p<0.001) among the three groups. A-NIRS values of NEC piglets remained lower throughout the study with mean for f-NEC of 69±3.8%, 71.9±4.04% for nf-NEC, and 78.4±1.8% for No-NEC piglets (p<0.001). A-NIRS <75% predicted NEC with 97% sensitivity and 97% specificity. NEC piglets demonstrated greater variability from baseline in A-NIRS than healthy piglets (10.1% vs. 6.3%; p=0.04). Mean pI-FABP levels were higher in animals that developed NEC compared to No-NEC piglets (0.66 vs. 0.09 ng/mL;p<0.001). In f-NEC piglets, pI-FABP increased precipitously after feeds (0.04 to 1.87 ng/mL;p<0.001). pI-FABP levels increased in parallel with disease progression and a value >0.25ng/mL identified animals with NEC (68% sensitivity and 90% specificity). NIRS is a real-time, non-invasive tool that can serve as a diagnostic modality for NEC. In premature piglets, low A-NIRS in the early neonatal period and increased variability during initial feeds are highly predictive of NEC, which is then confirmed by rising plasma I-FABP levels. These modalities may help identify neonates with NEC prior to clinical manifestations of disease.

No MeSH data available.


Related in: MedlinePlus

Continuous Abdominal NIRS-Tissue Oxygen Content of Hemoglobin (StO2) Measurements.Abdominal NIRS data stratified by NEC severity groups demonstrated that f-NEC piglets had significantly lower A-NIRS values than both the nf-NEC and No-NEC groups at baseline, and then both NEC groups maintained significantly lower A-NIRS values than No-NEC piglets throughout the majority of the study. ‡ = p<0.05, compared to Non-Fulminant NEC; * = p<0.05, compared to No-NEC.
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pone.0125437.g005: Continuous Abdominal NIRS-Tissue Oxygen Content of Hemoglobin (StO2) Measurements.Abdominal NIRS data stratified by NEC severity groups demonstrated that f-NEC piglets had significantly lower A-NIRS values than both the nf-NEC and No-NEC groups at baseline, and then both NEC groups maintained significantly lower A-NIRS values than No-NEC piglets throughout the majority of the study. ‡ = p<0.05, compared to Non-Fulminant NEC; * = p<0.05, compared to No-NEC.

Mentions: A-NIRS values were also significantly lower in animals that developed NEC compared to the No-NEC group, and remained lower throughout the study period (p<0.001) (Fig 5). The f-NEC group had the lowest A-NIRS baseline values. Despite the systemic oxygen saturation normalizing to levels comparable to the No-NEC piglets, the same was not true for A-NIRS, which never reached above 73%. A similar pattern was seen in the nf-NEC group, where A-NIRS values were also significantly lower than No-NEC piglets and levels never reached above 76% during the first 48 h of life, despite the SpO2 normalizing. At 36 h of life A-NIRS values diverged even greater from the healthy piglets and reached a trough of 67% approximately 24 h after the initiation of feeds. The average A-NIRS throughout all time points for f-NEC piglets was 69% ± 3.8%, 71.9% ± 4.04% for nf-NEC piglets, and 78.4% ± 1.8% for No-NEC piglets (p<0.001). On post-hoc analyses, the overall mean differences remained significant between the f-NEC and No-NEC piglets (p<0.001) and between nf-NEC piglets and the No-NEC group (p<0.001), but there was no difference between the two subgroups of NEC piglets (p = 0.087). On ROC curve analysis an A-NIRS < 75% identified animals progressing to NEC with 97% sensitivity and 97% specificity.


Low Abdominal NIRS Values and Elevated Plasma Intestinal Fatty Acid-Binding Protein in a Premature Piglet Model of Necrotizing Enterocolitis.

Zamora IJ, Stoll B, Ethun CG, Sheikh F, Yu L, Burrin DG, Brandt ML, Olutoye OO - PLoS ONE (2015)

Continuous Abdominal NIRS-Tissue Oxygen Content of Hemoglobin (StO2) Measurements.Abdominal NIRS data stratified by NEC severity groups demonstrated that f-NEC piglets had significantly lower A-NIRS values than both the nf-NEC and No-NEC groups at baseline, and then both NEC groups maintained significantly lower A-NIRS values than No-NEC piglets throughout the majority of the study. ‡ = p<0.05, compared to Non-Fulminant NEC; * = p<0.05, compared to No-NEC.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4465330&req=5

pone.0125437.g005: Continuous Abdominal NIRS-Tissue Oxygen Content of Hemoglobin (StO2) Measurements.Abdominal NIRS data stratified by NEC severity groups demonstrated that f-NEC piglets had significantly lower A-NIRS values than both the nf-NEC and No-NEC groups at baseline, and then both NEC groups maintained significantly lower A-NIRS values than No-NEC piglets throughout the majority of the study. ‡ = p<0.05, compared to Non-Fulminant NEC; * = p<0.05, compared to No-NEC.
Mentions: A-NIRS values were also significantly lower in animals that developed NEC compared to the No-NEC group, and remained lower throughout the study period (p<0.001) (Fig 5). The f-NEC group had the lowest A-NIRS baseline values. Despite the systemic oxygen saturation normalizing to levels comparable to the No-NEC piglets, the same was not true for A-NIRS, which never reached above 73%. A similar pattern was seen in the nf-NEC group, where A-NIRS values were also significantly lower than No-NEC piglets and levels never reached above 76% during the first 48 h of life, despite the SpO2 normalizing. At 36 h of life A-NIRS values diverged even greater from the healthy piglets and reached a trough of 67% approximately 24 h after the initiation of feeds. The average A-NIRS throughout all time points for f-NEC piglets was 69% ± 3.8%, 71.9% ± 4.04% for nf-NEC piglets, and 78.4% ± 1.8% for No-NEC piglets (p<0.001). On post-hoc analyses, the overall mean differences remained significant between the f-NEC and No-NEC piglets (p<0.001) and between nf-NEC piglets and the No-NEC group (p<0.001), but there was no difference between the two subgroups of NEC piglets (p = 0.087). On ROC curve analysis an A-NIRS < 75% identified animals progressing to NEC with 97% sensitivity and 97% specificity.

Bottom Line: NEC piglets demonstrated greater variability from baseline in A-NIRS than healthy piglets (10.1% vs. 6.3%; p=0.04).Mean pI-FABP levels were higher in animals that developed NEC compared to No-NEC piglets (0.66 vs. 0.09 ng/mL;p<0.001).In premature piglets, low A-NIRS in the early neonatal period and increased variability during initial feeds are highly predictive of NEC, which is then confirmed by rising plasma I-FABP levels.

View Article: PubMed Central - PubMed

Affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, United States of America.

ABSTRACT
To identify early markers of necrotizing enterocolitis (NEC), we hypothesized that continuous abdominal near-infrared spectroscopy (A-NIRS) measurement of splanchnic tissue oxygen saturation and intermittent plasma intestinal fatty-acid binding protein (pI-FABP) measured every 6 hours can detect NEC prior to onset of clinical symptoms. Premature piglets received parenteral nutrition for 48-hours after delivery, followed by enteral feeds every three hours until death or euthanasia at 96-hours. Continuous A-NIRS, systemic oxygen saturation (SpO2), and heart rate were measured while monitoring for clinical signs of NEC. Blood samples obtained at 6-hour intervals were used to determine pI-FABP levels by ELISA. Piglets were classified as fulminant-NEC (f-NEC), non-fulminant-NEC (nf-NEC) and No-NEC according to severity of clinical and histologic features. Of 38 piglets, 37% (n=14) developed nf-NEC, 18% (n=7) developed f-NEC and 45% (n=17) had No-NEC. There were significant differences in baseline heart rate (p=0.008), SpO2 (p<0.001) and A-NIRS (p<0.001) among the three groups. A-NIRS values of NEC piglets remained lower throughout the study with mean for f-NEC of 69±3.8%, 71.9±4.04% for nf-NEC, and 78.4±1.8% for No-NEC piglets (p<0.001). A-NIRS <75% predicted NEC with 97% sensitivity and 97% specificity. NEC piglets demonstrated greater variability from baseline in A-NIRS than healthy piglets (10.1% vs. 6.3%; p=0.04). Mean pI-FABP levels were higher in animals that developed NEC compared to No-NEC piglets (0.66 vs. 0.09 ng/mL;p<0.001). In f-NEC piglets, pI-FABP increased precipitously after feeds (0.04 to 1.87 ng/mL;p<0.001). pI-FABP levels increased in parallel with disease progression and a value >0.25ng/mL identified animals with NEC (68% sensitivity and 90% specificity). NIRS is a real-time, non-invasive tool that can serve as a diagnostic modality for NEC. In premature piglets, low A-NIRS in the early neonatal period and increased variability during initial feeds are highly predictive of NEC, which is then confirmed by rising plasma I-FABP levels. These modalities may help identify neonates with NEC prior to clinical manifestations of disease.

No MeSH data available.


Related in: MedlinePlus