Laparoscopy to Assist Surgical Decisions Related to Necrotizing Enterocolitis in Preterm Neonates
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Laparoscopy to Assist Surgical Decisions Related to Necrotizing Enterocolitis in Preterm Neonates. / Knudsen, Kristine Bach Korsholm; Thorup, Jorgen; Thymann, Thomas; Strandby, Rune; Nerup, Nikolaj; Achiam, Michael Patrick; Lauritsen, Torsten; Svendsen, Lars Bo; Buelund, Lene; Sangild, Per Torp; Ifaoui, Inge Botker Rasmussen.
In: Journal of Laparoendoscopic and Advanced Surgical Techniques, Vol. 30, No. 1, 2020, p. 64-69.Research output: Contribution to journal › Journal article › Research › peer-review
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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
Y1 - 2020
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.
KW - animal model
KW - diagnostic laparoscopy
KW - necrotizing enterocolitis
KW - surgical necrotizing enterocolitis
KW - ultrasound
U2 - 10.1089/lap.2018.0180
DO - 10.1089/lap.2018.0180
M3 - Journal article
C2 - 31874058
AN - SCOPUS:85077761129
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: 235588194