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Gabriela Olariu

Latest posts by Gabriela Olariu (see all)

  • MASURAREA PRIN SPECTROSCOPIE IN INFRAROSU A OXIGENARII TISULARE ABDOMINALE – UN INDICATOR UTIL AL ISCHEMIEI INTESTINALE LA NOU-NASCUTI - 17/07/2015
  • NEAR-INFRARED SPECTROSCOPY MEASUREMENT OF ABDOMINAL TISSUE OXYGENATION IS A USEFUL INDICATOR OF INTESTINAL ISCHEMIA IN NEONATES - 17/07/2015

Articole semnate de acelasi autor in Revista Romana de Pediatrie:

MASURAREA PRIN SPECTROSCOPIE IN INFRAROSU A OXIGENARII TISULARE ABDOMINALE – UN INDICATOR UTIL AL ISCHEMIEI INTESTINALE LA NOU-NASCUTI

SELECT ISSUE

Revista Romana de PEDIATRIE | Volumul LXIII, Nr. 3, An 2014
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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National Awards “Science and Research”

NEW! RJP has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

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Promoting Global Health

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MASURAREA PRIN SPECTROSCOPIE IN INFRAROSU A OXIGENARII TISULARE ABDOMINALE – UN INDICATOR UTIL AL ISCHEMIEI INTESTINALE LA NOU-NASCUTI

Laura Olariu, Gabriela Olariu, Sebastian Olariu and Otilia Marginean

ABSTRACT

Introducere. Ischemia intestinală neonatală este o patologie frecventă, dar din păcate, de multe ori subdiagnosticată. Tehnica actuală permite investigarea non-invazivă a circulaţiei la nivel splahnic, putând decela precoce modificările de perfuzie-oxigenare care apar la acest nivel.

Obiective. Scopul acestui studiu a fost de a determina valoarea clinică a spectroscopiei în infraroşu (NIRS) în detectarea precoce a modificărilor ischemice intestinale la nou-născuţii din secţia de Terapie Intensivă Neonatală.

Material şi metodă. Am efectuat un studiu prospectiv observaţional pe o perioadă de 18 luni, pe un lot de 15 nou-născuţi cu vârsta de gestaţie între 25-38 săptămâni. Toţi nou-născuţii luaţi în studiu au prezentat unul sau mai multe semne clinice de patologie digestivă. Începerea monitorizării non-invazive continue prin NIRS cerebrală şi abdominală s-a efectuat în momentul apariţiei primelor modificări digestive, între ziua 3-21 de viaţă. A fost măsurată saturaţia oxigenului la nivel cerebral şi abdominal (rSO2 -C şi rSO2 -A) şi s-a efectuat raportul oxigenării cerebro-splahnice (ROCS). În paralel nou-născuţii au fost monitorizaţi complex prin metode biologice şi paraclinice. Perioada de monitorizare a fost variabilă, fiind cuprinsă între 1-5 zile, perioadă necesară în stabilirea diagnosticului cauzal, şi apoi mai departe pentru urmărirea în dinamică a modificărilor perfuziei intestinale sub tratamentul instituit. Semnificaţia statistică a fost determinată folosind testul statistic t, calculând „p“ pentru un interval de încredere de 95% (semnificaţie statistică p < 0,05). De asemenea, a fost evaluată curba ROC pentru a determina capacitatea acestei tehnici de a fi un instrument de diagnostic.

Rezultate. Lotul de copii luaţi în studiu a inclus: 3 nou-născuţi cu malformaţie cardiacă congenitală (MCC) cu scăderea importantă a fluxului sanguin în aortă, 4 nou-născuţi cu enterocolită ulcero-necrotică (EUN) stadiul II, 3 pacienţi cu retard de creştere intrauterină (RCIU) formă severă, 1 nou-născut cu atrezie intestinală şi peritonită secundară, 1 nou-născut cu anemie prin incompatibilitate Rh cu anasarcă feto-placentară şi 3 pacienţi cu sepsis şi patologie digestivă asociată dar fără criterii de EUN. La toţi pacienţii valorile măsurătorilor NİRS au fost semnificativ scăzute faţă de valoarea normală, cu valori diferite în funcţie de severitatea afecţiunii. Valoarea medie a rSO2 -A a fost de 41,85 (interval de variaţie 15-85) faţă de o valoare medie considerată normală. De asemenea, valoarea medie a raportului ROCS a fost semnificativ scăzută faţă de valoarea normală. Cele mai mici valori ale rSO2 -A la începutul simptomatologiei le-a avut grupul de pacienţi cu MCC urmaţi de cei cu EUN. Aria de sub curba ROC a fost 0,95 (95% CI 0,88-1,02) pentru raportul ROCS. Considerând o valoare limită a ROCS pentru predicţia ischemiei intestinale de < 0,75, acest raport se dovedeşte a fi un indicator excelent al modificărilor circulaţiei intestinale.

Concluzii. Metoda NIRS are potenţialul de a detecta apariţia alterărilor în oxigenarea şi perfuzia intestinală, permiţând detectarea precoce a ischemiei intestinale, chiar înainte de modificarea altor parametri hemodinamici. NIRS este o metodă bună, non-invazivă, de urmărire în dinamică a modificărilor perfuziei tisulare sub tratamentul instituit, fiind de asemenea capabilă să ghideze tratamentul, având un real folos în practica clinică.

Cuvinte cheie: spectroscopie în infraroşu, nou-născuţi, saturaţia regională în oxigen, ischemie intestinală

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Laura Olariu

NEAR-INFRARED SPECTROSCOPY MEASUREMENT OF ABDOMINAL TISSUE OXYGENATION IS A USEFUL INDICATOR OF INTESTINAL ISCHEMIA IN NEONATES

SELECT ISSUE

Revista Romana de PEDIATRIE | Volumul LXIII, Nr. 3, An 2014
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

Indexed

DOI - Crossref
Similarity Check by iThenticate, worldwide No 1 professional plagiarism checking system
DOAJ
Scopus
NLM Catalog
Ebsco Host - Medline
Semantic Scholar

HIGHLIGHTS

National Awards “Science and Research”

NEW! RJP has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

The published medical research literature is a global public good. Medical journal editors have a social responsibility to promote global health by publishing, whenever possible, research that furthers health worldwide.

NEAR-INFRARED SPECTROSCOPY MEASUREMENT OF ABDOMINAL TISSUE OXYGENATION IS A USEFUL INDICATOR OF INTESTINAL ISCHEMIA IN NEONATES

Laura Olariu, Gabriela Olariu, Sebastian Olariu and Otilia Marginean

ABSTRACT

Introduction. Neonatal intestinal ischemia is a frequent pathology, but unfortunately, often underdiagnosed. Current technique allows non-invasive investigation of splanchnic circulation, being capable of detecting early perfusion changes that occur at this level.

Objectives. The aim of this study was to determine the clinical value of infrared spectroscopy (NIRS) 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 15 newborns with gestational age between 25-38 weeks. All infants included in the study had one or more clinical signs of digestive pathology. Starting non-invasive continuous monitoring by cerebral and abdominal 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 abdominal regions (rSO2 -C and rSO2 -A) and cerebro-splanchnic oxygenation ratio (CSOR) was carried out. Meanwhile infants were monitored by biological and hemodinamyc methods. The monitoring period was variable, being between 1-5 days, the period required for establish the causal diagnosis. Statistical significance was determined using statistical t-test. “p” was calculated for confidence interval of 95% (statistical signifi cance p < 0.05). Also was evaluated the area under the receiver operating characteristic (ROC) curve to determine the suitability of this technique as a diagnostic tool.

Results. The study group included: 3 neonates with congenital heart disease(CHD) with significant decrease in aortic blood flow, 4 neonates with necrotizing enterocolitis (NEC) stage II, 3 pacients with intrauterine growth retardation (IUGR) severe form, 1 newborn with intestinal atresia and secondary peritonitis, 1 newborn with Rh incompatibility anemia with placental anasarca and 3 pacients with sepsis and associated gastrointestinal pathology without NEC criteria. In all 15 patients, NIRS measurement values were significantly lower compared to the normal range, with different values depending on the severity of the condition. Mean rSO2 -A value was 41.85 (interquartile range15-85) compared to an average value, considered normal. Also the average value of the CSOR ratio was significantly lower compared to the normal. The lowest values of rSO2 -A at the beginning of simptoms has had the group of patients with CHD followed by those with NEC. The area under the ROC curve was 0.95 (95% CI 0.88 to 1.02) for the CSOR ratio. Considering a limit value of ROCS for prediction of intestinal ischemia < 0.75, this ratio proves to be an excellent indicator of changes in bowel 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. NIRS is a non-invasive, highly accurate method, to follow in evolution the changes in tissue perfusion under the treatment instituted, also being able to guide treatment, proving helpful in clinical practice.

Keywords: near infrared spectroscopy, neonates, regional oxygen saturation, intestinal ischemia

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Laura Olariu


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