DUGi

Splanchnic oxygenation trends monitored by NIRS for early detection of necrotizing enterocolitis in extremely preterm infants: a multicenter prospective observational cohort study

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BACKGROUND: Necrotizing enterocolitis (NEC) is a life-threatening intestinal disease that mainly affects premature infants, with the highest incidence and severity observed in those born at 28 weeks of gestation or less. Early diagnosis is difficult because initial signs are nonspecific and often mimic other common conditions of prematurity. In addition, definitive radiological findings often appear after irreversible necrosis has occurred. This leads to a critical delay in intervention and worse outcomes. However, intestinal ischemia is a key early pathogenic event. Near-infrared spectroscopy (NIRS) allows continuous non-invasive monitoring of splanchnic oxygenation (SrSO₂), but its clinical use has been limited by reliance on absolute thresholds with high inter-individual variability. Monitoring individual SrSO₂ trends may enable earlier and more personalized risk prediction. OBJECTIVE: To evaluate the association between a decrease in splanchnic regional oxygen saturation and the development of necrotizing enterocolitis within the subsequent 48 hours in preterm infants ≤28 weeks and, if confirmed, to develop and validate a predictive model with an optimal risk threshold. DESIGN: A prospective, multicenter, observational cohort study conducted in the neonatal intensive care units of two tertiary-care hospitals in Catalonia, Spain. Both centers are equipped with INVOS™ NIRS monitor and have specialized neonatal teams. PARTICIPANTS: Extremely preterm infants (≤28 weeks of gestation) admitted to participating units. METHODS: A total of 168 extreme premature infants will be consecutively recruited across the two participating hospitals. Continuous abdominal NIRS monitoring begins within the first 72 hours of life and continues until NEC diagnosis or until the completion of 30 days of monitoring. Daily median SrSO₂ values are calculated after artifact removal. For each eligible day from monitoring day 3 onward (designated “day 0”), the predictor ΔSrSO₂ is computed as (x₂ + x₃)/2 – x₁, where x₁, x₂, x₃ are the daily medians from days –2, –1, and 0, respectively. The outcome is NEC (Bell ≥ IIA) diagnosed in the 48 hours after day 0

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