NEAR-INFRARED SPECTROSCOPY IN DIFFERENTIAL DIAGNOSIS OF NECROTIZING ENTEROCOLITIS IN NEWBORNS, SPONTANEOUS PERFORATION OF THE INTESTINE AND CONGENITAL INTESTINAL OBSTRUCTION

Yaremenko S. O.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Necrotizing enterocolitis in neonates (NEC), spontaneous perforation of the intestines (CIP) and congenital gastrointestinal obstruction – acute diseases of the gastrointestinal tract, which in most cases require urgent surgical intervention, have negative consequences in the early and late postoperative period. The clinical course of these diseases in most cases in the early stages of the disease is similar, but the causes, pathogenesis and treatment outcomes are significantly different. The use of spectroscopy in the near-infrared spectrum can determine the regional saturation of tissues with oxygen by non-invasive methods. And since intestinal ischemia is associated with the development of NEC, the use of spectroscopy in the near-infrared spectrum may be useful in the diagnosis and differential diagnosis of necrotizing enterocolitis in newborns, SIP and congenital intestinal obstruction, especially in the early stages of the disease. The state of visceral hemodynamics was studied in 31 newborns with the impossibility of enteral nutrition and they formed the study group. 16 patients were diagnosed with NEC, 3 patients with spontaneous perforation of the intestine, 12 patients with congenital intestinal obstruction. All patients had similar clinical gastro-intestinal manifestations: abandonment of enteral nutrition, rupture with pathological impurities, bloating and abdominal pain, stomach upsets. All children of the study group performed clinical, laboratory-biochemical, ultrasound and X-ray studies and were additionally supplemented by measurements of abdominal regional saturation of tissues by oxygen-rSO2 spectroscopy in the near-infrared spectrum. Among patients with NEC, the complicated form (pneumoperitoneum) had 6 children. In patients with congenital obstruction obstruction was: at the level of the duodenum – 4 children (33%), at the level of the ileum – 6 children (50%), at the level of the colon – 2 children (17%). Patients with NEC had lower abdominal oxygen saturation indices than patients with SIP and congenital gastrointestinal obstruction. This indicates significant disorder of mesenteric hemodynamics in patients with NEC. Six patients with perforated NEC had abdominal oxygen saturation rates of less than 30% for 6 hours, they were operated after preoperative preparation (drainage of the abdominal cavity, infusion therapy), resection of the intestine and removal of double stomachs. In patients with SIP, the abdominal saturation of tissues with oxygen was within the normal range, indicating a local intestinal lesion, the diagnosis was confirmed by X-ray (pneumoperitoneum), and it was urgently carried out drainage of the abdominal cavity as a preoperative preparation. Subsequently, they did not require surgical intervention due to the self-closing perforation. In patients with congenital obstruction, the diagnosis was confirmed by X-ray, the abdominal oxygen saturation indices in the preoperative preparation period were within normal limits. The use of spectroscopy in the near-infrared spectrum allows for a differential diagnosis between diseases of the gastrointestinal tract with similar clinical manifestations. Low values of abdominal oxygen saturation in the NEC indicate a disorder of mesenteric hemodynamics and can be used as a control over the course of the disease and to determine the indications for surgical treatment.

necrotizing enterocolitis (NEC), diagnostics, newborns, near-infrared spectroscopy

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«Bulletin of problems biology and medicine» Issue 2 (144), 2018 year, 257-260 pages, index UDK 616.34-002.4-007.251/.272-053.31]-079.4-089:543.42

10.29254/2077-4214-2018-2-144-257-260