Application Value Of Near-infrared Spectroscopy In Neonatal Necrotizing Enterocolitis

Background:Presently,NEC remains to be one of the most common gastrointestinal emergencies in the NICU,early diagnosis is one of the key measures to enhance the prognosis of the disease and also a hotspot in recent years.Some studies at home and abroad have observed that NIRS technology is capable of indicating NEC onset in premature infants。There are some controversial conclusions due to the different equipment applied and few relevant studies carried out.Therefore,more researches is required to initiate to verify and reflect the application value of NIRS technology in neonatal NEC.Objective:The purpose of this study is to analyze the application value of NIRS technology in neonatal NEC from different perspectives,provide more data to stand by the existing conclusions,and further verify the diagnostic effect of NIRS technology in neonatal NEC,so as to provide more support for clinicians to identify and diagnose neonatal NEC.Methods:Utilizing the method of prospective observational case-control study,and analyzing the neonatal patients admitted to Jiangxi Provincial Children’s Hospital from July 1,2022 to March 1,2023,encompassing the case group（patients with NEC）and the control group（patients with non-NEC）.Cr SO₂,Sr SO₂were measured by NIRS device at different time points after admission with other NIRS-related indicators like c FTOE,s FTOE,SCOR deduced;meanwhile,clinical information and laboratory test results such as the gestational age,postnatal age,age at onset,birth weight,number of fetus,delivery mode,Sp O₂,HGB,PLT,CRP and so on were gathered.（?）±s and relative numbers were used for statistical description;t-test,x²-test,Fisher’s exact test,Spearman correlation test,logistic regression etc were applied for analyzing the data.Sensitivity,specificity,Youden index,AUC and others were used to analyze the diagnostic effect.Results:1.A total of 37 cases were enrolled in the NEC group and the control group,HGB and CRP in the NEC group were statistically different from the control group（P<0.05）.There were no significant differences in the ratio of men to women,gestational age,postnatal age,birth weight,weight after admission,head circumference,number of fetus,mode of delivery,feeding mode,history of asphyxia and hypoxia,maternal history of diseases during pregnancy,amniotic fluid contamination,neonatal blood glucose,pulmonary hypertension,PDA,SGA,BPD and PLT counts in the NEC group compared with the control group（P>0.05）.2.The Sr SO₂of term infants and preterm infants in the control group were（60.19±4.41）%and（61.49±3.04）%respectively,and the Cr SO₂of them were（61.49±3.04）%and（63.30±2.24%）%respectively,and there were no significant differences in the Sr SO₂ and Cr SO₂ between these two kinds of newborn in the control group（P>0.05）;there were statistical differences in the association between Cr SO₂ and HGB in the control group（P<0.05）,while there were no significant differences in the association between Sr SO₂ and Cr SO₂ with GA and PNA,and between Sr SO₂ and HGB（P>0.05）.3.The Sr SO₂ in the NEC group and the control group were（52.04±9.22）%and（60.65±3.99）%separately,the s FTOE in these two groups were 0.45±0.10 and0.37±0.04 separately,the SCOR in these two groups were 0.84±0.15 and 0.96±0.07respectively,and there were statistical differences in the Sr SO₂,s FTOE and SCOR（P<0.05）;the Cr SO₂ in these two groups were（62.01±3.68）%and（62.98±2.31）%separately,the c FTOE in these two groups were 0.35±0.04 and 0.34±0.03 separately,yet there were no significant differences in the Cr SO₂ and c FTOE between the two groups（P>0.05）.4.There were statistical differences in Sr SO₂ and s FTOE between the early-onset and late-onset NEC groups（P<0.05）,there were no significant differences in Cr SO₂,c FTOE and SCOR between the two groups（P>0.05）;there were no significant differences in Sr SO₂,Cr SO₂,s FTOE,c FTOE and SCOR between the term group and the preterm group（P>0.05）;likewise,there were no significant differences in Sr SO₂,Cr SO₂,s FTOE,c FTOE and SCOR between the conservative treatment group and the surgical treatment group（P>0.05）.5.There were no significant differences in associations among Sr SO₂,Cr SO₂,s FTOE,c FTOE,and SCOR with Bell stage with NEC in neonates（P>0.05）6.In term infants with NEC who are conservatively treated,There were no significant differences in the correlation among NIRS data（Sr SO₂,Cr SO₂,s FTOE,c FTOE,SCOR）within 24 hours of NEC diagnosis,NIRS data when Sr SO₂ was lowest and the days of hospital stay before intestinal oxygen improvement with the length of hospital stay（P>0.05）.7.The AUC of Sr SO₂ for the diagnosis of NEC was 0.796,and its optimal cut-off value was Sr SO₂<54.2%,the diagnostic sensitivity was 64.90%,and the specificity was 94.60%.The AUC of s FTOE for the diagnosis of NEC was 0.793,the optimal cut-off value was s FTOE>0.435,the diagnostic sensitivity was 67.60%,and the specificity was 94.60%.The AUC of SCOR for NEC diagnosis is 0.771,its optimal cut-off value is SCOR<0.855,diagnostic sensitivity is 59.50%,and specificity is97.30%.The AUC comparison showed that the AUC of Sr SO₂ alone for NEC diagnosis was higher than that of s FTOE and SCOR,and the differences were of no statistical significance（P>0.05）.8.Mode1 diagnosed NEC with an AUC of 0.826,a diagnostic sensitivity of 73%,and a specificity of 91.9%.Mode2 diagnosed NEC with an AUC of 0.815,a diagnostic sensitivity of 73%,and a specificity of 91.9%.Mode3 diagnosed NEC with an AUC of 0.825,a diagnostic sensitivity of 62.2%,and a specificity of 97.3%.The AUC comparison showed that Mode1 had the highest AUC for NEC,but there were no significant differences in AUC among Sr SO₂,Mode1,Mode2,Mode3（P>0.05）.Conclusion:1.By using EGOS-600A,Sr SO₂<54.2%of neonates may indicate the occurrence of NEC;2.The diagnostic value of Sr SO₂ alone in neonatal NEC was comparable to that of s FTOE,SCOR as well as Sr SO₂ combined with HGB and/or CRP.3.Sr SO₂,Cr SO₂,s FTOE,c FTOE and SCOR may be of little significance for indicating the timing of surgery.