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Laparoscopy to Assist Surgical Decisions Related to Necrotizing Enterocolitis in Preterm Neonates

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@article{67e654d45a6943759a5b8cb660eaffba,
title = "Laparoscopy to Assist Surgical Decisions Related to Necrotizing Enterocolitis in Preterm Neonates",
abstract = "Aim of the Study: Necrotizing enterocolitis (NEC) is a devastating intestinal disease that mainly affects preterm infants. Despite advancements in neonatal care, mortality of NEC remains high and controversies exist regarding the most appropriate time for surgical intervention and challenging of diagnosing NEC. Using a pig model of NEC, we aimed to examine if laparoscopy is feasible for diagnosis of NEC. Methods: Preterm caesarean-delivered piglets (n = 42) were fed with increasing amounts of infant formula up to 5 days to induce NEC. On days 3-5, we examined the intestine by laparoscopy under general anesthesia. The bowel was examined by tilting the pigs from supine position to the left and right side. Macroscopic NEC lesions were identified and graded according to a macroscopic scoring system, then a laparotomy was performed to rule out any organ injury and missed NEC lesions. Results: Visible NEC lesions (scores 4-6) were found in 26{\%} (11/42) of the piglets. A positive predictive value of 100{\%} was found for laparoscopy as a diagnostic marker of NEC in both colon and the small intestine. One piglet had a higher NEC score in the small intestine found at laparotomy, than at laparoscopy, resulting in a sensitivity of 67{\%}, and a specificity of 100{\%} for the small intestine. Conversely, both the sensitivity and specificity for colon was 100{\%}. Acceptable levels of agreement was found, with minimal proportional bias in both colon and the small intestine for laparoscopy and laparotomy. Ultrasound examination had a lower sensitivity of 67{\%} and specificity of 63{\%}. All piglets were respiratory and circulatory stable during the procedure. Conclusions: In preterm piglets, laparoscopy is a feasible tool to diagnose NEC with a high positive predictive value and a high specificity.",
author = "Knudsen, {Kristine Bach Korsholm} and Jorgen Thorup and Thomas Thymann and Rune Strandby and Nikolaj Nerup and Achiam, {Michael Patrick} and Torsten Lauritsen and Svendsen, {Lars Bo} and Lene Buelund and Sangild, {Per Torp} and Ifaoui, {Inge Botker Rasmussen}",
year = "2020",
month = "1",
doi = "10.1089/lap.2018.0180",
language = "English",
volume = "30",
pages = "64--69",
journal = "Journal of Laparoendoscopic and Advanced Surgical Techniques - Part A",
issn = "1092-6429",
publisher = "Mary Ann/Liebert, Inc. Publishers",
number = "1",

}

RIS

TY - JOUR

T1 - Laparoscopy to Assist Surgical Decisions Related to Necrotizing Enterocolitis in Preterm Neonates

AU - Knudsen, Kristine Bach Korsholm

AU - Thorup, Jorgen

AU - Thymann, Thomas

AU - Strandby, Rune

AU - Nerup, Nikolaj

AU - Achiam, Michael Patrick

AU - Lauritsen, Torsten

AU - Svendsen, Lars Bo

AU - Buelund, Lene

AU - Sangild, Per Torp

AU - Ifaoui, Inge Botker Rasmussen

PY - 2020/1

Y1 - 2020/1

N2 - Aim of the Study: Necrotizing enterocolitis (NEC) is a devastating intestinal disease that mainly affects preterm infants. Despite advancements in neonatal care, mortality of NEC remains high and controversies exist regarding the most appropriate time for surgical intervention and challenging of diagnosing NEC. Using a pig model of NEC, we aimed to examine if laparoscopy is feasible for diagnosis of NEC. Methods: Preterm caesarean-delivered piglets (n = 42) were fed with increasing amounts of infant formula up to 5 days to induce NEC. On days 3-5, we examined the intestine by laparoscopy under general anesthesia. The bowel was examined by tilting the pigs from supine position to the left and right side. Macroscopic NEC lesions were identified and graded according to a macroscopic scoring system, then a laparotomy was performed to rule out any organ injury and missed NEC lesions. Results: Visible NEC lesions (scores 4-6) were found in 26% (11/42) of the piglets. A positive predictive value of 100% was found for laparoscopy as a diagnostic marker of NEC in both colon and the small intestine. One piglet had a higher NEC score in the small intestine found at laparotomy, than at laparoscopy, resulting in a sensitivity of 67%, and a specificity of 100% for the small intestine. Conversely, both the sensitivity and specificity for colon was 100%. Acceptable levels of agreement was found, with minimal proportional bias in both colon and the small intestine for laparoscopy and laparotomy. Ultrasound examination had a lower sensitivity of 67% and specificity of 63%. All piglets were respiratory and circulatory stable during the procedure. Conclusions: In preterm piglets, laparoscopy is a feasible tool to diagnose NEC with a high positive predictive value and a high specificity.

AB - Aim of the Study: Necrotizing enterocolitis (NEC) is a devastating intestinal disease that mainly affects preterm infants. Despite advancements in neonatal care, mortality of NEC remains high and controversies exist regarding the most appropriate time for surgical intervention and challenging of diagnosing NEC. Using a pig model of NEC, we aimed to examine if laparoscopy is feasible for diagnosis of NEC. Methods: Preterm caesarean-delivered piglets (n = 42) were fed with increasing amounts of infant formula up to 5 days to induce NEC. On days 3-5, we examined the intestine by laparoscopy under general anesthesia. The bowel was examined by tilting the pigs from supine position to the left and right side. Macroscopic NEC lesions were identified and graded according to a macroscopic scoring system, then a laparotomy was performed to rule out any organ injury and missed NEC lesions. Results: Visible NEC lesions (scores 4-6) were found in 26% (11/42) of the piglets. A positive predictive value of 100% was found for laparoscopy as a diagnostic marker of NEC in both colon and the small intestine. One piglet had a higher NEC score in the small intestine found at laparotomy, than at laparoscopy, resulting in a sensitivity of 67%, and a specificity of 100% for the small intestine. Conversely, both the sensitivity and specificity for colon was 100%. Acceptable levels of agreement was found, with minimal proportional bias in both colon and the small intestine for laparoscopy and laparotomy. Ultrasound examination had a lower sensitivity of 67% and specificity of 63%. All piglets were respiratory and circulatory stable during the procedure. Conclusions: In preterm piglets, laparoscopy is a feasible tool to diagnose NEC with a high positive predictive value and a high specificity.

U2 - 10.1089/lap.2018.0180

DO - 10.1089/lap.2018.0180

M3 - Journal article

VL - 30

SP - 64

EP - 69

JO - Journal of Laparoendoscopic and Advanced Surgical Techniques - Part A

JF - Journal of Laparoendoscopic and Advanced Surgical Techniques - Part A

SN - 1092-6429

IS - 1

ER -

ID: 59085225