Intestinal perfusion assessed by quantitative fluorescence angiography in piglets with necrotizing enterocolitis

Kristine Bach Korsholm Knudsen; Nikolaj Nerup; Joergen Thorup; Thomas Thymann; Per Torp Sangild; Lars Bo Svendsen; Michael Achiam; Morten Bo Soendergaard Svendsen; Torsten Lauritsen; Lisa Leth Maroun; Inge Boetker Rasmussen Ifaoui

doi:10.1016/j.jpedsurg.2021.10.021

Intestinal perfusion assessed by quantitative fluorescence angiography in piglets with necrotizing enterocolitis

Kristine Bach Korsholm Knudsen, Nikolaj Nerup, Joergen Thorup, Thomas Thymann, Per Torp Sangild, Lars Bo Svendsen, Michael Achiam, Morten Bo Soendergaard Svendsen, Torsten Lauritsen, Lisa Leth Maroun, Inge Boetker Rasmussen Ifaoui

Research output: Contribution to journal › Journal article › Research › peer-review

2 Citations (Scopus)

Abstract

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.

Original language	English
Journal	Journal of Pediatric Surgery
Volume	57
Issue number	4
Pages (from-to)	747-752
Number of pages	6
ISSN	0022-3468
DOIs	https://doi.org/10.1016/j.jpedsurg.2021.10.021
Publication status	Published - 2022

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10.1016/j.jpedsurg.2021.10.021

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Bach Korsholm Knudsen, K., Nerup, N., Thorup, J., Thymann, T., Sangild, P. T., Svendsen, L. B., Achiam, M., Svendsen, M. B. S., Lauritsen, T., Leth Maroun, L., & Ifaoui, I. B. R. (2022). Intestinal perfusion assessed by quantitative fluorescence angiography in piglets with necrotizing enterocolitis. Journal of Pediatric Surgery, 57(4), 747-752. https://doi.org/10.1016/j.jpedsurg.2021.10.021

Intestinal perfusion assessed by quantitative fluorescence angiography in piglets with necrotizing enterocolitis. / Bach Korsholm Knudsen, Kristine; Nerup, Nikolaj; Thorup, Joergen; Thymann, Thomas ; Sangild, Per Torp ; Svendsen, Lars Bo ; Achiam, Michael; Svendsen, Morten Bo Soendergaard; Lauritsen, Torsten; Leth Maroun, Lisa; Ifaoui, Inge Boetker Rasmussen.

In: Journal of Pediatric Surgery, Vol. 57, No. 4, 2022, p. 747-752.

Research output: Contribution to journal › Journal article › Research › peer-review

Bach Korsholm Knudsen, K, Nerup, N, Thorup, J, Thymann, T , Sangild, PT , Svendsen, LB , Achiam, M, Svendsen, MBS, Lauritsen, T, Leth Maroun, L & Ifaoui, IBR 2022, 'Intestinal perfusion assessed by quantitative fluorescence angiography in piglets with necrotizing enterocolitis', Journal of Pediatric Surgery, vol. 57, no. 4, pp. 747-752. https://doi.org/10.1016/j.jpedsurg.2021.10.021

Bach Korsholm Knudsen, Kristine ; Nerup, Nikolaj ; Thorup, Joergen ; Thymann, Thomas ; Sangild, Per Torp ; Svendsen, Lars Bo ; Achiam, Michael ; Svendsen, Morten Bo Soendergaard ; Lauritsen, Torsten ; Leth Maroun, Lisa ; Ifaoui, Inge Boetker Rasmussen. / Intestinal perfusion assessed by quantitative fluorescence angiography in piglets with necrotizing enterocolitis. In: Journal of Pediatric Surgery. 2022 ; Vol. 57, No. 4. pp. 747-752.

@article{0013385c517f47549cd86a50c03c267d,

title = "Intestinal perfusion assessed by quantitative fluorescence angiography in piglets with necrotizing enterocolitis",

abstract = "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.",

author = "{Bach Korsholm Knudsen}, Kristine and Nikolaj Nerup and Joergen Thorup and Thomas Thymann and Sangild, {Per Torp} and Svendsen, {Lars Bo} and Michael Achiam and Svendsen, {Morten Bo Soendergaard} and Torsten Lauritsen and {Leth Maroun}, Lisa and Ifaoui, {Inge Boetker Rasmussen}",

note = "Copyright {\textcopyright} 2021. Published by Elsevier Inc.",

year = "2022",

doi = "10.1016/j.jpedsurg.2021.10.021",

language = "English",

volume = "57",

pages = "747--752",

journal = "Journal of Pediatric Surgery",

issn = "0022-3468",

publisher = "W.B.Saunders Co.",

number = "4",

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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

PY - 2022

Y1 - 2022

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.

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 -