Meltem BOR, Özkan İLHAN
İstanbul Medical Journal - 2026;27(1):70-76
Introduction: Necrotizing enterocolitis (NEC) is a major cause of morbidity and mortality in preterm infants. Early detection of impaired intestinal perfusion may support preventive strategies. Near-infrared spectroscopy (NIRS) is a non-invasive bedside method that continuously measures regional tissue oxygenation. This study aimed to assess whether baseline regional cerebral oxygen saturation (rcSO2), regional mesenteric/splanchnic oxygen saturation (rsSO2), and their ratio (SCOR), measured within the first 24-48 hours of life, could predict the development of NEC. Methods: This prospective cohort study included preterm infants with gestational age <34 weeks and/or birth weight <1250 g. Infants were classified as NEC or as controls (no NEC and no feeding intolerance). Baseline rcSO2 and rsSO2 values were continuously recorded for one hour between 24 and 48 hours postnatal using NIRS. Demographic, maternal, and clinical data were obtained from hospital records. Appropriate parametric and non-parametric tests were used; p<0.05 was considered significant. Results: Forty infants were included (NEC, n=18; control, n=22). Gestational age (29.27+/-1.64 vs. 29.50+/-2.18 weeks; p=0.923) and birth weight (1378.18+/-275.55 g vs. 1226.67+/-271.27 g; p=0.187) were similar between groups. Small-for-gestational-age status was observed only in the NEC group (16.7%; p=0.083). Hematocrit levels were significantly higher in the NEC group (mean +/- standard deviation: 52.44+/-7.38% vs. 46.11+/-5.97%; p=0.006). Baseline rcSO2 was slightly higher and rsSO2 was slightly lower in infants who developed NEC, but these differences were not statistically significant (p>0.05). SCOR values were comparable (median= 0.7). Time to reach full enteral feeding was significantly longer in the NEC group (30.5 vs. 18.5 days; p=0.001). Conclusion: Baseline cerebral and splanchnic NIRS values within the first 48 hours of life did not predict the development of NEC. Elevated hematocrit levels may indicate early circulatory vulnerability by altering microcirculation. Continuous, trend-based NIRS monitoring, in combination with clinical and biochemical parameters, may improve the prediction of NEC.
