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Mesenteric near-infrared spectroscopy and risk of gastrointestinal complications in infants undergoing surgery for congenital heart disease*

Published online by Cambridge University Press:  07 September 2015

Ilias Iliopoulos ,
Ricardo G. Branco ,
Nadine Brinkhuis ,
Anke Furck ,
Joan LaRovere ,
David S. Cooper  and
Nazima Pathan
Ilias Iliopoulos*
Affiliation:
Paediatric Intensive Care Unit, Royal Brompton Hospital, London, United Kingdom Cardiac Intensive Care Unit, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
Ricardo G. Branco
Affiliation:
Paediatric Intensive Care Unit, Royal Brompton Hospital, London, United Kingdom Paediatric Intensive Care Unit, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
Nadine Brinkhuis
Affiliation:
Paediatric Intensive Care Unit, Royal Brompton Hospital, London, United Kingdom
Anke Furck
Affiliation:
Paediatric Intensive Care Unit, Royal Brompton Hospital, London, United Kingdom
Joan LaRovere
Affiliation:
Paediatric Intensive Care Unit, Royal Brompton Hospital, London, United Kingdom Division of Cardiovascular Critical Care, Children’s Hospital Boston, United States of America
David S. Cooper
Affiliation:
Cardiac Intensive Care Unit, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
Nazima Pathan
Affiliation:
Paediatric Intensive Care Unit, Royal Brompton Hospital, London, United Kingdom Paediatric Intensive Care Unit, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom Department of Paediatrics, University of Cambridge, United Kingdom
*
Correspondence to: Dr I. Iliopoulos, MD, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 2003, Cincinnati, OH 45229-3026, United States of America. Tel: +1 513 803 9218; Fax: +1 513 636 3952; Email: ilias.iliopoulos@cchmc.org
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Abstract

We hypothesised that lower mesenteric near-infrared spectroscopy values would be associated with a greater incidence of gastrointestinal complications in children weighing <10 kg who were recovering from cardiac surgery. We evaluated mesenteric near-infrared spectroscopy, central venous oxygen saturation, and arterial blood gases for 48 hours post-operatively. Enteral feeding intake, gastrointestinal complications, and markers of organ dysfunction were monitored for 7 days. A total of 50 children, with median age of 16.7 (3.2–31.6) weeks, were studied. On admission, the average mesenteric near-infrared spectroscopy value was 71±18%, and the systemic oxygen saturation was 93±7.5%. Lower admission mesenteric near-infrared spectroscopy correlated with longer time to establish enteral feeds (r=−0.58, p<0.01) and shorter duration of feeds at 7 days (r=0.48, p<0.01). Children with gastrointestinal complications had significantly lower admission mesenteric near-infrared spectroscopy (58±18% versus 73±17%, p=0.01) and higher mesenteric arteriovenous difference of oxygen at admission [39 (23–47) % versus 19 (4–27) %, p=0.02]. Based on multiple logistic regression, admission mesenteric near-infrared spectroscopy was independently associated with gastrointestinal complications (Odds ratio, 0.95; 95% confidence interval, 0.93–0.97; p=0.03). Admission mesenteric near-infrared spectroscopy showed an area under the receiver operating characteristic curve of 0.76 to identify children who developed gastrointestinal complications, with a suggested cut-off value of 72% (78% sensitivity, 68% specificity). In this pilot study, we conclude that admission mesenteric near-infrared spectroscopy is associated with gastrointestinal complications and enteral feeding tolerance in children after cardiac surgery.

Keywords

Near-infrared spectroscopyfeeding toleranceCHDmesenteric perfusiongastrointestinal complicationcardiac surgery
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 4 , April 2016 , pp. 772 - 780
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Copyright
© Cambridge University Press 2015 

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Footnotes

*

This work was performed at the Paediatric Intensive Care Unit at the Royal Brompton Hospital, London, United Kingdom. The abstract of this study was presented at “Cardiology 2012: The 16th Annual Update on Pediatric and Congenital Cardiovascular Disease, Orlando, Florida, February 22–26, 2012”, World Journal for Pediatric and Congenital Heart Surgery, 2012.

†

I.I. and R.B. contributed equally to this study.

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