Oral or Poster Presentation
Concurrent Session 3A - Neonatal Clinical Epidemiology
Introduction: Necrotizing enterocolitis (NEC) is associated with poor outcome indicating the need for new treatments. Remote ischemic conditioning (RIC) consisting of brief cycles of ischemia-reperfusion can protect distant organs from sustained ischemic damage. Our studies indicate that RIC promotes the resolution of experimental NEC by improving intestinal morphology, reducing inflammation, and enhancing survival. Our aim was to test the feasibility and safety of RIC in preterm infants with NEC.
Methods: This feasibility and safety trial was performed from December 2018 to August 2019. Preterm infants (GA < 36 weeks; weight >750 grams) with NEC were eligible. RIC was done by inflating/deflating a blood pressure cuff around a limb with a manual sphygmomanometer. There were 3 consecutive phases. An independent committee of experts determined feasibility/safety before enrolling patients into the next phase. Phase A (n=5): four cycles of ischemia of increasing duration (1 to 4 minutes); phase B (n=5): up to four cycles of maximal ischemia as tolerated in phase A; Phase C (n=5): cycles as in phase B but repeated after 24 hours. Feasibility (RIC performed as in the protocol) and safety (perfusion and oxygen saturation returning to baseline within 4 minutes after cuff deflation) were measured.
Results: Fifteen patients (GA 25.9±2.8 weeks and weight 837.8±400 g) were enrolled. RIC was feasible, and distal perfusion and saturation returned to baseline within 4 minutes in every patient after RIC. No patient developed oligo-anuria, lost the grasp reflex or showed new-onset cutaneous injury. Analgesia was increased in 10% of patients six hours after RIC. There was no significant change in PIPP score between cycles (Figure).
Conclusion: RIC (up to four ischemia cycles of 4 minutes in two consecutive days) is feasible and safe in preterm infants with NEC. This data is essential for establishing a randomized controlled trial to prove the efficacy of RIC in NEC.