近红外光谱技术在早期识别新生儿胃肠道疾病中的应用

古丽佐合热·阿里木江; 努尔亚·热加甫

doi:10.7499/j.issn.1008-8830.2311148

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中国当代儿科杂志 ›› 2024, Vol. 26 ›› Issue (5) : 523-528. DOI: 10.7499/j.issn.1008-8830.2311148

综述

近红外光谱技术在早期识别新生儿胃肠道疾病中的应用

古丽佐合热·阿里木江, 努尔亚·热加甫

作者信息 +

Application of near-infrared spectroscopy in the early identification of neonatal gastrointestinal diseases

Gulizuohere· ALIMUJIANG, Nuerya· REJIAFU

Author information +

文章历史 +

摘要

新生儿坏死性小肠结肠炎（necrotizing enterocolitis, NEC）是新生儿重症监护病房最常见的胃肠道疾病之一，进展迅速，病死率较高，肠道局部缺血缺氧是导致NEC的重要原因。喂养不耐受（feeding intolerance, FI）指不能耐受肠内营养而出现的一系列胃肠道表现，是目前新生儿最常见的临床问题之一，防治FI对提高新生儿存活率意义重大。近红外光谱是一种可用于床旁监测区域氧饱和度的临床工具，具有无创、可靠、可持续等优点，在测定肠道血液循环状况方面其可行性和安全性也得到了验证。早期识别肠道缺血并鉴别FI与NEC的前驱症状，预测NEC的发生，对减少肠道损伤及远期不良预后极为重要。近年来，对监测肠道组织氧饱和度和脑组织氧饱和度以早期识别FI与NEC的前驱症状相关临床事件有了新的研究进展。该文对近年来近红外光谱在监测新生儿NEC及FI区域血氧方面的应用进展及相关成果进行综述。

Abstract

Necrotizing enterocolitis (NEC) is one of the most common gastrointestinal diseases in neonatal intensive care units, characterized by rapid progression and a high mortality rate. Local intestinal ischemia and hypoxia are significant contributors to NEC. Feeding intolerance (FI), which refers to a range of gastrointestinal manifestations arising from the inability to tolerate enteral nutrition, is one of the most common clinical issues in neonates, and preventing and treating FI is crucial for improving neonatal survival rates. Near-infrared spectroscopy is a clinical tool that can be used at the bedside to monitor regional oxygen saturation. It is non-invasive, reliable, and sustainable, and its feasibility and safety in assessing intestinal blood circulation have been validated. Early identification of intestinal ischemia and differentiation of FI from precursor symptoms of NEC, as well as predicting the occurrence of NEC, are extremely important for reducing intestinal injury and adverse long-term outcomes. In recent years, there has been new research progress related to the monitoring of intestinal tissue oxygen saturation and cerebral oxygen saturation for the early identification of FI and precursor symptoms of NEC, and this article provides a review of these developments.

导出引用

古丽佐合热·阿里木江, 努尔亚·热加甫. 近红外光谱技术在早期识别新生儿胃肠道疾病中的应用[J]. 中国当代儿科杂志. 2024, 26(5): 523-528 https://doi.org/10.7499/j.issn.1008-8830.2311148

Gulizuohere· ALIMUJIANG, Nuerya· REJIAFU. Application of near-infrared spectroscopy in the early identification of neonatal gastrointestinal diseases[J]. Chinese Journal of Contemporary Pediatrics. 2024, 26(5): 523-528 https://doi.org/10.7499/j.issn.1008-8830.2311148

参考文献

1 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 5版. 北京: 人民卫生出版社, 2019: 632-639.
2 李佳美, 梁会营. 近10年早产儿坏死性小肠结肠炎文献计量分析[J]. 中国现代医生, 2022, 60(31): 73-77.
3 Duchon J, Barbian ME, Denning PW. Necrotizing enterocolitis[J]. Clin Perinatol, 2021, 48(2): 229-250. PMID: 34030811. DOI: 10.1016/j.clp.2021.03.002.
4 Mishra V, Cuna A, Singh R, et al. Imaging for diagnosis and assessment of necrotizing enterocolitis[J]. Newborn (Clarksville), 2022, 1(1): 182-189. PMID: 36864828. PMCID: PMC9976546. DOI: 10.5005/jp-journals-11002-0002.
5 Hong L, Huang Y, Jiang S, et al. Postnatal dynamics and clinical associations of fecal calprotectin in very preterm infants: implications for necrotizing enterocolitis and feeding intolerance[J]. Clin Transl Gastroenterol, 2023, 14(8): e00604. PMID: 37272666. PMCID: PMC10461937. DOI: 10.14309/ctg.0000000000000604.
6 Berken JA, Chang J. Neurologic consequences of neonatal necrotizing enterocolitis[J]. Dev Neurosci, 2022, 44(4/5): 295-308. PMID: 35697005. DOI: 10.1159/000525378.
7 Albraik RK, Shatla E, Abdulla YM, et al. Neonatal feeding intolerance and its characteristics: a descriptive study[J]. Cureus, 2022, 14(9): e29291. PMID: 36277537. PMCID: PMC9578381. DOI: 10.7759/cureus.29291.
8 Meister AL, Doheny KK, Travagli RA. Necrotizing enterocolitis: it's not all in the gut[J]. Exp Biol Med (Maywood), 2020, 245(2): 85-95. PMID: 31810384. PMCID: PMC7016421. DOI: 10.1177/1535370219891971.
9 Ortigoza EB. Feeding intolerance[J]. Early Hum Dev, 2022, 171: 105601. PMID: 35728504. PMCID: PMC9995226. DOI: 10.1016/j.earlhumdev.2022.105601.
10 Pavlek LR, Mueller C, Jebbia MR, et al. Near-infrared spectroscopy in extremely preterm infants[J]. Front Pediatr, 2021, 8: 624113. PMID: 33553078. PMCID: PMC7859523. DOI: 10.3389/fped.2020.624113.
11 Wu S, Di S, Liu T, et al. Emerging prediction methods for early diagnosis of necrotizing enterocolitis[J]. Front Med (Lausanne), 2022, 9: 985219. PMID: 36186788. PMCID: PMC9523100. DOI: 10.3389/fmed.2022.985219.
12 毛建雄, 肖东, 张翅, 等. 近红外光谱技术在新生儿坏死性小肠结肠炎肠道血氧饱和度测定中的研究[J]. 中国优生与遗传杂志, 2019, 27(7): 841-843. DOI: 10.13404/j.cnki.cjbhh.2019.07.023.
13 Duess JW, Sampah ME, Lopez CM, et al. Necrotizing enterocolitis, gut microbes, and sepsis[J]. Gut Microbes, 2023, 15(1): 2221470. PMID: 37312412. PMCID: PMC10269420. DOI: 10.1080/19490976.2023.2221470.
14 Howarth C, Banerjee J, Leung T, et al. Could near infrared spectroscopy (NIRS) be the new weapon in our fight against necrotising enterocolitis?[J]. Front Pediatr, 2022, 10: 1024566. PMID: 36425397. PMCID: PMC9679512. DOI: 10.3389/fped.2022.1024566.
15 Mishra V, Mathur AA, Mohamed S, et al. Role of near-infrared spectroscopy in the diagnosis and assessment of necrotizing enterocolitis[J]. Newborn (Clarksville), 2022, 1(1): 177-181. PMID: 36864826. PMCID: PMC9976547. DOI: 10.5005/jp-journals-11002-0001.
16 Schat TE, van der Laan ME, Schurink M, et al. Abdominal near-infrared spectroscopy in preterm infants: a comparison of splanchnic oxygen saturation measurements at two abdominal locations[J]. Early Hum Dev, 2014, 90(7): 371-375. PMID: 24811448. DOI: 10.1016/j.earlhumdev.2014.04.008.
17 毛建雄, 肖东, 罗燕, 等. 近红外光谱技术在测定新生儿坏死性小肠结肠炎脑血氧饱和度和判定肠坏死程度的探讨[J]. 岭南现代临床外科, 2020, 20(5): 562-566. DOI: 10.3969/j.issn.1009-976X.2020.05.004.
18 Gillam-Krakauer M, Cochran CM, Slaughter JC, et al. Correlation of abdominal rSO2 with superior mesenteric artery velocities in preterm infants[J]. J Perinatol, 2013, 33(8): 609-612. PMID: 23392317. PMCID: PMC3655136. DOI: 10.1038/jp.2013.3.
19 Bailey SM, Hendricks-Munoz KD, Mally P. Cerebral , renal, and splanchnic tissue oxygen saturation values in healthy term newborns[J]. Am J Perinatol, 2014, 31(4): 339-344. PMID: 23873114. DOI: 10.1055/s-0033-1349894.
20 McNeill S, Gatenby JC, McElroy S, et al. Normal cerebral, renal and abdominal regional oxygen saturations using near-infrared spectroscopy in preterm infants[J]. J Perinatol, 2011, 31(1): 51-57. PMID: 20539273. PMCID: PMC3013378. DOI: 10.1038/jp.2010.71.
21 Howarth CN, Leung TS, Banerjee J, et al. Regional cerebral and splanchnic tissue oxygen saturation in preterm infants: longitudinal normative measurements[J]. Early Hum Dev, 2022, 165: 105540. PMID: 35065416. DOI: 10.1016/j.earlhumdev.2022.105540.
22 van der Heide M, Dotinga BM, Stewart RE, et al. Regional splanchnic oxygen saturation for preterm infants in the first week after birth: reference values[J]. Pediatr Res, 2021, 90(4): 882-887. PMID: 33504960. DOI: 10.1038/s41390-020-01323-3.
23 张敬华, 关瑞莲, 潘翩翩, 等. 极/超低出生体重儿生后早期腹部局部组织氧饱和度变化趋势的前瞻性研究[J]. 中国当代儿科杂志, 2021, 23(10): 1015-1020. PMID: 34719416. PMCID: PMC8549648. DOI: 10.7499/j.issn.1008-8830.2105156.
24 Cortez J, Gupta M, Amaram A, et al. Noninvasive evaluation of splanchnic tissue oxygenation using near-infrared spectroscopy in preterm neonates[J]. J Matern Fetal Neonatal Med, 2011, 24(4): 574-582. PMID: 20828232. DOI: 10.3109/14767058.2010.511335.
25 Corvaglia L, Martini S, Battistini B, et al. Splanchnic oxygenation at first enteral feeding in preterm infants: correlation with feeding intolerance[J]. J Pediatr Gastroenterol Nutr, 2017, 64(4): 550-554. PMID: 27467111. DOI: 10.1097/MPG.0000000000001308.
26 李旭芳, 关瑞莲, 程婷婷, 等. 近红外光谱法监测极低出生体质量儿早期喂养不耐受腹部血氧饱和度的变化[J]. 中国基层医药, 2017, 24(1): 76-79. DOI: 10.3760/cma.j.issn.1008-6706.2017.01.020.
27 Palleri E, Wackernagel D, Wester T, et al. Low splanchnic oxygenation and risk for necrotizing enterocolitis in extremely preterm newborns[J]. J Pediatr Gastroenterol Nutr, 2020, 71(3): 401-406. PMID: 32404748. DOI: 10.1097/MPG.0000000000002761.
28 Palleri E, van der Heide M, Hulscher JBF, et al. Clinical usefulness of splanchnic oxygenation in predicting necrotizing enterocolitis in extremely preterm infants: a cohort study[J]. BMC Pediatr, 2023, 23(1): 336. PMID: 37393233. PMCID: PMC10314466. DOI: 10.1186/s12887-023-04145-4.
29 Schat TE, van Zoonen AGJF, van der Laan ME, et al. Early cerebral and intestinal oxygenation in the risk assessment of necrotizing enterocolitis in preterm infants[J]. Early Hum Dev, 2019, 131: 75-80. PMID: 30870625. DOI: 10.1016/j.earlhumdev.2019.03.001.
30 Patel AK, Lazar DA, Burrin DG, et al. Abdominal near-infrared spectroscopy measurements are lower in preterm infants at risk for necrotizing enterocolitis[J]. Pediatr Crit Care Med, 2014, 15(8): 735-741. PMID: 25068253. DOI: 10.1097/PCC.0000000000000211.
31 Fortune PM, Wagstaff M, Petros AJ. Cerebro-splanchnic oxygenation ratio (CSOR) using near infrared spectroscopy may be able to predict splanchnic ischaemia in neonates[J]. Intensive Care Med, 2001, 27(8): 1401-1407. PMID: 11511955. DOI: 10.1007/s001340100994.
32 Zabaneh RN, Cleary JP, Lieber CA. Mesentric oxygen saturations in premature twins with and without necrotizing enterocolitis[J]. Pediatr Crit Care Med, 2011, 12(6): e404-e406. PMID: 21116207. DOI: 10.1097/PCC.0b013e3181fe4278.
33 van der Heide M, Hulscher JBF, Bos AF, et al. Near-infrared spectroscopy as a diagnostic tool for necrotizing enterocolitis in preterm infants[J]. Pediatr Res, 2021, 90(1): 148-155. PMID: 33036017. DOI: 10.1038/s41390-020-01186-8.
34 Schat TE, Schurink M, van der Laan ME, et al. Near-infrared spectroscopy to predict the course of necrotizing enterocolitis[J]. PLoS One, 2016, 11(5): e0154710. PMID: 27183233. PMCID: PMC4868291. DOI: 10.1371/journal.pone.0154710.
35 Le Bouhellec J, Prodhomme O, Mura T, et al. Near-infrared spectroscopy: a tool for diagnosing necrotizing enterocolitis at onset of symptoms in preterm neonates with acute gastrointestinal symptoms?[J]. Am J Perinatol, 2021, 38(S1): e299-e308. PMID: 32325507. DOI: 10.1055/s-0040-1710033.
36 Cuna A, Chan S, Jones J, et al. Feasibility and acceptability of a diagnostic randomized clinical trial of bowel ultrasound in infants with suspected necrotizing enterocolitis[J]. Eur J Pediatr, 2022, 181(8): 3211-3215. PMID: 35713688. PMCID: PMC9203774. DOI: 10.1007/s00431-022-04526-4.
37 Aladangady N, Sanderson I. Editorial: biomarkers of gut blood flow, oxygenation, inflammation and NEC in neonates[J]. Front Pediatr, 2023, 11: 1234832. PMID: 37484771. PMCID: PMC10359896. DOI: 10.3389/fped.2023.1234832.
38 Goldstein GP, Sylvester KG. Biomarker discovery and utility in necrotizing enterocolitis[J]. Clin Perinatol, 2019, 46(1): 1-17. PMID: 30771811. DOI: 10.1016/j.clp.2018.10.001.
39 彭文玲, 宋小燕, 黄为民. 近红外光谱在新生儿坏死性小肠结肠炎中的研究进展[J]. 中华实用儿科临床杂志, 2018, 33(7): 550-552. DOI: 10.3760/cma.j.issn.2095-428X.2018.07.017.
40 Kuik SJ, Kalteren WS, Mebius MJ, et al. Predicting intestinal recovery after necrotizing enterocolitis in preterm infants[J]. Pediatr Res, 2020, 87(5): 903-909. PMID: 31649338. DOI: 10.1038/s41390-019-0634-y.
41 接双双, 戴立英, 张健, 等. 肠道局部组织氧饱和度和C-反应蛋白在诊断早产儿坏死性小肠结肠炎中的价值[J]. 中国当代儿科杂志, 2022, 24(11): 1202-1206. PMID: 36398544. PMCID: PMC9678065. DOI: 10.7499/j.issn.1008-8830.2204047.
42 Heath M, Buckley R, Gerber Z, et al. Association of intestinal alkaline phosphatase with necrotizing enterocolitis among premature infants[J]. JAMA Netw Open, 2019, 2(11): e1914996. PMID: 31702803. PMCID: PMC6902776. DOI: 10.1001/jamanetworkopen.2019.14996.
43 Sher Y, Olm MR, Raveh-Sadka T, et al. Combined analysis of microbial metagenomic and metatranscriptomic sequencing data to assess in situ physiological conditions in the premature infant gut[J]. PLoS One, 2020, 15(3): e0229537. PMID: 32130257. PMCID: PMC7055874. DOI: 10.1371/journal.pone.0229537.
44 Qi Y, Liu C, Zhong X, et al. IL-27 as a potential biomarker for distinguishing between necrotising enterocolitis and highly suspected early-onset food protein-induced enterocolitis syndrome with abdominal gas signs[J]. EBioMedicine, 2021, 72: 103607. PMID: 34628355. PMCID: PMC8511805. DOI: 10.1016/j.ebiom.2021.103607.