UTILITATEA METODEI SPECTROSCOPIEI IN INFRAROSU PENTRU DEPISTAREA PRECOCE A ISCHEMIEI INTESTINALE LA NOU-NASCUT.

Introduction: Neonatal intestinal ischemia is a frequent pathology, but often underdiagnosed. Current technique allows non-invasive investigation of splanchnic circulation, being able of detecting early perfusion changes that occur at this level. Objectives: To determine the clinical value of near-infrared spectroscopy (NIRS) method in early detection of ischemic bowel modifications in newborns from neonatal intensive care unit. Material and methods: We performed a prospective observational study over a period of 18 months on a group of 30 newborns with gestational age between 25-39 weeks, with clinical signs of digestive pathology. Starting non-invasive continuous monitoring by NIRS was performed according to the appearance of the first digestive changes, between day 3 and 21 of life. Oxygen saturation was measured in the cerebral and splanchnic regions (rSO2-C and rSO2-S) and cerebro-splanchnic oxygenation ratio (CSOR) was made. The infants were also monitored by biological and hemodinamyc methods. The monitoring period was variable, between 1-5 days, the period required for establish the causal diagnosis. Statistical significance was determined using statistical t-test. "p" was calculated for confi dence interval of 95% (statistical significance p < 0.05). Also was evaluated the area under the ROC curve to determine the suitability of this technique as a diagnostic tool. Results: The study group included: 6 neonates with congenital heart disease(CHD) with significant decrease in aortic blood flow, 12 with necrotizing enterocolitis (NEC) stage II, 6 with intrauterine growth retardation (IUGR) severe form and 6 pacients with sepsis and associated gastrointestinal pathology without NEC criteria. In all patients, NIRS measurement values were significantly lower compared to the normal range, with different values depending on the severity of the condition. Also the average value of the CSOR was significantly lower compared to the normal. The lowest values of rSO2-S at the beginning of simptoms has had the NEC group followed by those with CHD. Interpretation of the area under the ROC curve shows that rSO2-S and CSOR are excellent indicators of changes in intestinal circulation. Conclusion: NIRS method has the potential to detect the occurrence of alterations in intestinal oxygenation and perfusion, allowing early detection of bowel ischemia, just before the modification of other hemodynamic parameters. [ABSTRACT FROM AUTHOR]