Intestinal Oxygenation and Survival After Surgery for Necrotizing Enterocolitis An Observational Cohort Study

Objective: To assess whether regional intestinal oxygen saturation (r(int)SO(2)) and regional cerebral oxygen saturation (r(c)SO(2)) measurements aid in estimating survival of preterm infants after surgery for NEC. Summary of Background Data: Predicting survival after surgery for NEC is difficult yet of the utmost importance for counseling parents. Methods: We retrospectively studied prospectively collected data of preterm infants with surgical NEC who had available r(int)SO(2) and r(c)SO(2) values measured via near-infrared spectroscopy 0-24 hours preoperatively. We calculated mean r(int)SO(2) and r(c)SO(2) for 60-120 minutes for each infant. We analyzed whether preoperative r(int)SO(2) and r(c)SO(2) differed between survivors and non-survivors, determined cut-off points, and assessed the added value to clinical variables. Results: We included 22 infants, median gestational age 26.9 weeks [interquartile range (IQR): 26.3-28.4], median birth weight 1088 g [IQR: 730-1178]. Eleven infants died postoperatively. Preoperative r(int)SO(2), but not r(c)SO(2), was higher in survivors than in non-survivors [median: 63% (IQR: 42-68) vs 29% (IQR: 21-43), P < 0.01), with odds ratio for survival 4.1 (95% confidence interval, 1.2-13.9, P = 0.02) per 10% higher r(int)SO(2). All infants with r(int)SO(2) values of >53% survived, whereas all infants with r(int)SO(2) <35% died. Median C-reactive protein [138 mg/L (IQR: 83-179) vs 73 mg/L (IQR: 12-98), P < 0.01), lactate [1.1 mmol/L (IQR: 1.0-1.6) vs 4.6 mmol/L (IQR: 2.8-8.0), P < 0.01], and fraction of inspired oxygen [25% (IQR: 21-31) vs 42% (IQR: 30-80), P < 0.01] differed between survivors and non-survivors. Only r(int)SO(2) remained significant in the multiple regression model. Conclusions: Measuring r(int)SO(2), but not r(c)SO(2), seems of added value to clinical variables in estimating survival of preterm infants after surgery for NEC. This may help clinicians in deciding whether surgery is feasible and to better counsel parents about their infants' chances of survival.