TY - JOUR
T1 - Intestinal perfusion assessed by quantitative fluorescence angiography in piglets with necrotizing enterocolitis
AU - Bach Korsholm Knudsen, Kristine
AU - Nerup, Nikolaj
AU - Thorup, Joergen
AU - Thymann, Thomas
AU - Sangild, Per Torp
AU - Svendsen, Lars Bo
AU - Achiam, Michael
AU - Svendsen, Morten Bo Soendergaard
AU - Lauritsen, Torsten
AU - Leth Maroun, Lisa
AU - Ifaoui, Inge Boetker Rasmussen
N1 - Copyright © 2021. Published by Elsevier Inc.
PY - 2022/4
Y1 - 2022/4
N2 - BACKGROUND: Reduced intestinal perfusion is thought to be a part of the pathogenesis in necrotizing enterocolitis (NEC). This study aims to evaluate the intestinal perfusion assessment in NEC-lesions by quantitative fluorescence angiography with indocyanine green (q-ICG) during laparoscopy and open surgery.METHODS: Thirty-four premature piglets were delivered by cesarean section and fed with parenteral nutrition and increasing infant formula volumes to induce NEC. During surgery, macroscopic NEC-lesions were evaluated using a validated macroscopic scoring system (1-6 for increasing NEC severity). The intestinal perfusion was assessed by q-ICG and quantified with a validated pixel intensity computer algorithm.RESULTS: Significantly higher perfusion values were found in healthy areas of the colon (score 1) compared to those with NEC scores of 4, 5, and 6 (p < 0.05). Similarly, in the small intestine, perfusion was higher in the intestine with areas scored 1 compared to scores of 3 and 4 (p < 0.05). A cut-off value was found between NEC score of 1-2 vs. 3-4 for the small intestine at 117 and for colon at 107 between NEC scores 12 vs. scores of 36 with an area less than the curve value at 0.9 (p < 0.05).CONCLUSIONS: q-ICG seems to be a feasible and valuable technique to evaluate the perfusion of tissue with NEC-lesions. We found a cut-off between intestine with scores 1-2 and intestine with NEC scores 3-6 in colon, and NEC score 3-4 in the small intestine.LEVEL OF EVIDENCE: II.
AB - BACKGROUND: Reduced intestinal perfusion is thought to be a part of the pathogenesis in necrotizing enterocolitis (NEC). This study aims to evaluate the intestinal perfusion assessment in NEC-lesions by quantitative fluorescence angiography with indocyanine green (q-ICG) during laparoscopy and open surgery.METHODS: Thirty-four premature piglets were delivered by cesarean section and fed with parenteral nutrition and increasing infant formula volumes to induce NEC. During surgery, macroscopic NEC-lesions were evaluated using a validated macroscopic scoring system (1-6 for increasing NEC severity). The intestinal perfusion was assessed by q-ICG and quantified with a validated pixel intensity computer algorithm.RESULTS: Significantly higher perfusion values were found in healthy areas of the colon (score 1) compared to those with NEC scores of 4, 5, and 6 (p < 0.05). Similarly, in the small intestine, perfusion was higher in the intestine with areas scored 1 compared to scores of 3 and 4 (p < 0.05). A cut-off value was found between NEC score of 1-2 vs. 3-4 for the small intestine at 117 and for colon at 107 between NEC scores 12 vs. scores of 36 with an area less than the curve value at 0.9 (p < 0.05).CONCLUSIONS: q-ICG seems to be a feasible and valuable technique to evaluate the perfusion of tissue with NEC-lesions. We found a cut-off between intestine with scores 1-2 and intestine with NEC scores 3-6 in colon, and NEC score 3-4 in the small intestine.LEVEL OF EVIDENCE: II.
KW - Indocyanine green
KW - Intestinal viability
KW - Necrotizing enterocolitis
KW - Neonates
KW - Perfusion
UR - http://www.scopus.com/inward/record.url?scp=85123886385&partnerID=8YFLogxK
U2 - 10.1016/j.jpedsurg.2021.10.021
DO - 10.1016/j.jpedsurg.2021.10.021
M3 - Journal article
C2 - 34872732
VL - 57
SP - 747
EP - 752
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
SN - 0022-3468
IS - 4
ER -