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Mesenteric Oxygenation Changes Associated With Necrotizing Enterocolitis and Pneumoperitoneum After Multiple Blood Transfusions: A Case Report

Marin, Terri, PhD, NNP-BC, FAANP; Moore, James E., MD, PhD

Section Editor(s): Newnam, Katherine PhD, RN, NNP-BC, CPNP, IBCLE; ; Schierholz, Elizabeth MSN, NNP;

doi: 10.1097/ANC.0000000000000461
Case of the Month

Background: The multifactorial pathology and broad clinical presentation of necrotizing enterocolitis (NEC) development in premature infants make prediction of disease onset extremely challenging. Over the past decade, packed red blood cell (PRBC) transfusions have been temporally linked to the development of NEC in severely anemic preterm infants, although this issue is highly controversial.

Purpose: In this case study, we describe events of an extremely low birth-weight infant who developed NEC complicated by pneumoperitoneum after receiving multiple PRBC transfusions. Specifically, we describe mesenteric tissue oxygenation trend changes as measured by continuous near-infrared spectroscopy (NIRS) technology.

Methods: As part of a larger prospective, observational investigation, this infant was monitored with NIRS (INVOS 5100C; Medtronic, Boulder, Colorado) before, during, and 48 hours following PRBC transfusions.

Results: The infant demonstrated severe, prolonged, and persistent reductions in mesenteric tissue oxygenation following blood transfusions, yet routine physiologic monitoring did not indicate intestinal hypoperfusion or impending NEC onset.

Implications for Practice: This report demonstrates the ability of NIRS to capture possible tissue ischemia during early stages of NEC that may help guide bedside therapeutic interventions.

Implications for Research: Larger cohort studies to evaluate the ability of NIRS to capture early tissue ischemia are essential to validate the feasibility of adding this technology as a routine clinical bedside tool.

Video Abstract available at

Department of Physiological and Technological Nursing, College of Nursing, Augusta University, Georgia (Dr Marin); and University of Connecticut Health Science Center, Farmington, and Connecticut Children's Medical Center, Hartford, Connecticut (Dr Moore).

Correspondence: Terri Marin, PhD, NNP-BC, FAANP, Department of Physiological and Technological Nursing, College of Nursing, Augusta University, Augusta, GA 30912 (

The work was conducted at Emory University Midtown Hospital Neonatal Intensive Care Unit, Atlanta, Georgia.

This work was supported in part by the Florida Association of Neonatal Nurse Practitioners organization through an awarded grant to Dr Terri Marin.

Dr Marin has received honoraria from the National Association of Neonatal Nurses, and Florida Association of Neonatal Nurse Practitioners for presentations related to this work.

Dr Marin and Dr Moore are educational consultants for Medtronic, the manufacturer of the near-infrared spectroscopy device used in this research, which involves educating medical and nursing personnel on the application of the device in the neonatal intensive care unit.

Dr Marin composed the initial draft of this article and received subsequent input from Dr Moore.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

The authors declare no conflicts of interest.

© 2018 by The National Association of Neonatal Nurses