{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T05:57:52Z","timestamp":1781243872131,"version":"3.54.1"},"reference-count":109,"publisher":"Georg Thieme Verlag KG","issue":"06","funder":[{"DOI":"10.13039\/100000057","name":"NIGMS","doi-asserted-by":"crossref","award":["U54GM115428"],"award-info":[{"award-number":["U54GM115428"]}],"id":[{"id":"10.13039\/100000057","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:p>Necrotizing enterocolitis (NEC) is one of the most common gastrointestinal emergencies in preterm infants. The pathogenesis of NEC is not clearly established and multifactorial. Preterm infants are at increased risk for NEC because of intestinal immaturity, resulting in potential mucosal injury. Circulatory instability has been proposed as a key indicator for ischemic insult to the gut, leading to NEC. With the increased incidence of patent ductus arteriosus (PDA) in preterm infants less than 32 weeks and in babies with birth weight less than 1,500\u2009g, several studies propose an association of NEC with a hemodynamically significant PDA. This review provides an extensive literature search for NEC and PDA in the PUBMED database. In this study, we will review the pathogenesis of NEC and the relationship between PDA and NEC. We will also explore the different treatment options for PDA and their relationship to the incidence of NEC. While earlier diagnosis and aggressive treatment of NEC have improved the outcomes, the disease still accounts for 10% of deaths in infants in the neonatal intensive care unit. With resuscitation of increasingly earlier gestational age infants, the incidence of both hemodynamically significant PDA and NEC is rising, denoting the importance of understanding the inter-relationship of these two pathophysiological processes.<\/jats:p>","DOI":"10.1055\/a-2685-2169","type":"journal-article","created":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T23:09:47Z","timestamp":1755644987000},"page":"707-717","source":"Crossref","is-referenced-by-count":1,"title":["Clinical Impact of the PDA and Its Management on Outcomes of Preterm Infants with NEC: A Review"],"prefix":"10.1055","volume":"43","author":[{"given":"Vignesh","family":"Gunasekaran","sequence":"additional","affiliation":[{"name":"Department of Pediatrics\/Neonatology, West Virginia University School of Medicine, Martinsburg, West Virginia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo J.","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Department of Pediatrics\/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Porcelli","sequence":"additional","affiliation":[{"name":"Department of Pediatrics\/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5430-848X","authenticated-orcid":false,"given":"Nilima","family":"Jawale","sequence":"additional","affiliation":[{"name":"Department of Pediatrics\/Neonatology, SUNY Upstate Medical University, Syracuse, New York, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Shenberger","sequence":"additional","affiliation":[{"name":"Department of Pediatrics\/Neonatology, Connecticut Children's, Hartford, Connecticut, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parvesh M.","family":"Garg","sequence":"additional","affiliation":[{"name":"Department of Pediatrics\/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,8,29]]},"reference":[{"issue":"05","key":"ref1","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1016\/j.jpedsurg.2018.02.014","article-title":"Necrotizing enterocolitis in patients with congenital heart disease: a single center experience","volume":"53","author":"P E Lau","year":"2018","journal-title":"J Pediatr Surg"},{"issue":"05","key":"ref2","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1542\/peds.106.5.1080","article-title":"Necrotizing enterocolitis in neonates with congenital heart disease: risk factors and outcomes","volume":"106","author":"D B McElhinney","year":"2000","journal-title":"Pediatrics"},{"issue":"395","key":"ref3","first-page":"1","article-title":"Mortality in the United States, 2019","author":"K D Kochanek","year":"2020","journal-title":"NCHS Data Brief"},{"issue":"06","key":"ref4","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1016\/j.jpedsurg.2020.02.046","article-title":"Trends in incidence and outcomes of necrotizing enterocolitis over the last 12\u202fyears: a multicenter cohort analysis","volume":"55","author":"S M Han","year":"2020","journal-title":"J Pediatr Surg"},{"issue":"06","key":"ref5","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1111\/j.1365-3016.2006.00756.x","article-title":"Necrotising enterocolitis hospitalisations among neonates in the United States","volume":"20","author":"R C Holman","year":"2006","journal-title":"Paediatr Perinat Epidemiol"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1542\/peds.110.1.143","article-title":"Trends in mortality and morbidity for very low birth weight infants, 1991-1999","volume":"110","author":"J D Horbar","year":"2002","journal-title":"Pediatrics"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1007\/s10753-024-02054-x","article-title":"Epigenetic insights into necrotizing enterocolitis: unraveling methylation-regulated biomarkers","volume":"48","author":"B Tian","year":"2025","journal-title":"Inflammation"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1007\/s00383-023-05619-3","article-title":"Necrotizing enterocolitis: current understanding of the prevention and management","volume":"40","author":"X Hu","year":"2024","journal-title":"Pediatr Surg Int"},{"issue":"01","key":"ref9","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1038\/s41390-024-03074-x","article-title":"Reassessing acquired neonatal intestinal diseases using unsupervised machine learning","volume":"96","author":"D R Gipson","year":"2024","journal-title":"Pediatr Res"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"4","DOI":"10.12688\/f1000research.6888.1","article-title":"Necrotizing enterocolitis: controversies and challenges","volume":"4","author":"A Zani","year":"2015","journal-title":"F1000 Res"},{"issue":"07","key":"ref11","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1016\/j.jpedsurg.2009.12.002","article-title":"National prospective surveillance study of necrotizing enterocolitis in neonatal intensive care units","volume":"45","author":"C M Rees","year":"2010","journal-title":"J Pediatr Surg"},{"issue":"02","key":"ref12","doi-asserted-by":"crossref","first-page":"e298","DOI":"10.1542\/peds.2011-2022","article-title":"Incidence and timing of presentation of necrotizing enterocolitis in preterm infants","volume":"129","author":"W H Yee","year":"2012","journal-title":"Pediatrics"},{"issue":"10","key":"ref13","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1001\/jama.2015.10244","article-title":"Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012","volume":"314","author":"B J Stoll","year":"2015","journal-title":"JAMA"},{"issue":"06","key":"ref14","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1016\/j.jamcollsurg.2013.11.015","article-title":"Mortality and management of surgical necrotizing enterocolitis in very low birth weight neonates: a prospective cohort study","volume":"218","author":"M A Hull","year":"2014","journal-title":"J Am Coll Surg"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.jpeds.2019.11.011","article-title":"Contemporary outcomes for infants with necrotizing enterocolitis-a systematic review","volume":"220","author":"I H Jones","year":"2020","journal-title":"J Pediatr"},{"issue":"03","key":"ref16","first-page":"145","article-title":"The infancy of the CVMA: 1948-1967","volume":"39","author":"C A Barker","year":"1998","journal-title":"Can Vet J"},{"issue":"12","key":"ref17","doi-asserted-by":"crossref","first-page":"1875","DOI":"10.1007\/s00431-019-03440-6","article-title":"Neonates living with enterostomy following necrotising enterocolitis are at high risk of becoming severely underweight","volume":"178","author":"C Chong","year":"2019","journal-title":"Eur J Pediatr"},{"issue":"03","key":"ref18","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1542\/peds.2004-0569","article-title":"Neurodevelopmental and growth outcomes of extremely low birth weight infants after necrotizing enterocolitis","volume":"115","author":"S R Hintz","year":"2005","journal-title":"Pediatrics"},{"issue":"03","key":"ref19","doi-asserted-by":"crossref","first-page":"F193","DOI":"10.1136\/adc.2006.099929","article-title":"Neurodevelopmental outcomes of 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neonates","volume":"3","author":"H Nagasawa","year":"2016","journal-title":"Open Heart"},{"issue":"03","key":"ref35","first-page":"138","article-title":"Patent ductus arteriosus: an overview","volume":"12","author":"J E Dice","year":"2007","journal-title":"J Pediatr Pharmacol Ther"},{"issue":"04","key":"ref36","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1152\/ajplegacy.1972.222.4.841","article-title":"Guinea pig ductus arteriosus. II. Irreversible closure after birth","volume":"222","author":"F S Fay","year":"1972","journal-title":"Am J Physiol"},{"issue":"05","key":"ref37","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1203\/00006450-199805000-00012","article-title":"Regulation of ductus arteriosus patency by nitric oxide in fetal lambs: the role of gestation, oxygen tension, and vasa vasorum","volume":"43","author":"R I Clyman","year":"1998","journal-title":"Pediatr Res"},{"issue":"01","key":"ref38","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1203\/00006450-199901000-00005","article-title":"Permanent anatomic closure of the ductus arteriosus in newborn baboons: the roles of postnatal constriction, hypoxia, and gestation","volume":"45","author":"R I Clyman","year":"1999","journal-title":"Pediatr Res"},{"issue":"06","key":"ref39","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1016\/S0022-3476(83)80023-7","article-title":"Effect of gestational age on ductus arteriosus response to circulating prostaglandin E2","volume":"102","author":"R I Clyman","year":"1983","journal-title":"J Pediatr"},{"issue":"01","key":"ref40","doi-asserted-by":"crossref","first-page":"E1","DOI":"10.1542\/peds.107.1.e1","article-title":"Very low birth weight outcomes of the National Institute of Child health and human development neonatal research network, January 1995 through December 1996","volume":"107","author":"J A Lemons","year":"2001","journal-title":"Pediatrics"},{"issue":"04","key":"ref41","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1542\/peds.2005-1528","article-title":"Prevalence of spontaneous closure of the ductus arteriosus in neonates at a birth weight of 1000 grams or less","volume":"117","author":"J Koch","year":"2006","journal-title":"Pediatrics"},{"key":"ref42","doi-asserted-by":"crossref","first-page":"280","DOI":"10.3389\/fped.2017.00280","article-title":"Development of a diagnostic clinical score for hemodynamically significant patent ductus arteriosus","volume":"5","author":"A Kindler","year":"2017","journal-title":"Front Pediatr"},{"issue":"01","key":"ref43","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1038\/s41372-020-00866-x","article-title":"Association of chorioamnionitis and patent ductus arteriosus in a national U.S. cohort","volume":"41","author":"C A Green","year":"2021","journal-title":"J Perinatol"},{"issue":"01","key":"ref44","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s13052-021-00956-2","article-title":"Morbidity associated with patent ductus arteriosus in preterm newborns: a retrospective case-control study","volume":"47","author":"G Terrin","year":"2021","journal-title":"Ital J Pediatr"},{"key":"ref45","doi-asserted-by":"crossref","first-page":"408","DOI":"10.3389\/fped.2019.00408","article-title":"Intraventricular hemorrhage: risk factors and association with patent ductus arteriosus treatment in extremely preterm neonates","volume":"7","author":"I Khanafer-Larocque","year":"2019","journal-title":"Front Pediatr"},{"issue":"07","key":"ref46","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1164\/rccm.202203-0570OC","article-title":"Patent ductus arteriosus and development of bronchopulmonary dysplasia-associated pulmonary hypertension","volume":"207","author":"S J Gentle","year":"2023","journal-title":"Am J Respir Crit Care Med"},{"issue":"05","key":"ref47","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1542\/peds.94.5.719","article-title":"Pulmonary hemorrhage risk in infants with a clinically diagnosed patent ductus arteriosus: a retrospective cohort study","volume":"94","author":"J Garland","year":"1994","journal-title":"Pediatrics"},{"issue":"03","key":"ref48","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1007\/s00431-021-04266-x","article-title":"Risk factors for mortality in preterm infants with necrotizing enterocolitis: a retrospective multicenter analysis","volume":"181","author":"M Kordasz","year":"2022","journal-title":"Eur J Pediatr"},{"issue":"06","key":"ref49","doi-asserted-by":"crossref","first-page":"1441","DOI":"10.1038\/s41372-021-01054-1","article-title":"Relationship of patent ductus arteriosus management with neonatal AKI","volume":"41","author":"R Guillet","year":"2021","journal-title":"J Perinatol"},{"issue":"01","key":"ref50","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1186\/s12887-024-04607-3","article-title":"Factors influencing necrotizing enterocolitis in premature infants in China: a systematic review and meta-analysis","volume":"24","author":"S Zhao","year":"2024","journal-title":"BMC Pediatr"},{"key":"ref51","doi-asserted-by":"crossref","first-page":"1257694","DOI":"10.3389\/fped.2024.1257694","article-title":"Should we \u201celiminate\u201d PDA shunt in preterm infants? A narrative review","volume":"12","author":"A Surak","year":"2024","journal-title":"Front Pediatr"},{"issue":"06","key":"ref52","doi-asserted-by":"crossref","first-page":"F424","DOI":"10.1136\/adc.2007.118117","article-title":"Towards rational management of the patent ductus arteriosus: the need for disease staging","volume":"92","author":"P J McNamara","year":"2007","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"issue":"01","key":"ref53","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1055\/s-0037-1605576","article-title":"Tale of two patent ductus arteriosus severity scores: similarities and differences","volume":"35","author":"D Fink","year":"2018","journal-title":"Am J Perinatol"},{"issue":"01","key":"ref54","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1111\/chd.12708","article-title":"PDA: to treat or not to treat","volume":"14","author":"M N Sankar","year":"2019","journal-title":"Congenit Heart 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Pediatr"},{"key":"ref58","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.jpeds.2018.09.012","article-title":"PDA-tolerate trial: an exploratory randomized controlled trial of treatment of moderate-to-large patent ductus arteriosus at 1 week of age","volume":"205","author":"R I Clyman","year":"2019","journal-title":"J Pediatr"},{"issue":"02","key":"ref59","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1203\/00006450-199602000-00015","article-title":"Mesenteric blood flow velocity and its relation to transitional circulatory adaptation in appropriate for gestational age preterm infants","volume":"39","author":"M Martinussen","year":"1996","journal-title":"Pediatr Res"},{"issue":"07","key":"ref60","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1038\/jp.2010.200","article-title":"Regional tissue oxygenation in preterm born infants in association with echocardiographically significant patent ductus arteriosus","volume":"31","author":"A Petrova","year":"2011","journal-title":"J Perinatol"},{"issue":"07","key":"ref61","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1038\/sj.jp.7211294","article-title":"The hemodynamic effects of neonatal patent ductus arteriosus shunting on superior mesenteric artery blood flow","volume":"25","author":"M Freeman-Ladd","year":"2005","journal-title":"J Perinatol"},{"issue":"06","key":"ref62","doi-asserted-by":"crossref","first-page":"e1262","DOI":"10.1542\/peds.2008-2045","article-title":"Effects of a patent ductus arteriosus on postprandial mesenteric perfusion in premature baboons","volume":"122","author":"D McCurnin","year":"2008","journal-title":"Pediatrics"},{"key":"ref63","doi-asserted-by":"crossref","first-page":"257","DOI":"10.3389\/fped.2020.00257","article-title":"Clinical characteristics of necrotizing enterocolitis in preterm patients with and without persistent ductus arteriosus and in patients with congenital heart disease","volume":"8","author":"S Diez","year":"2020","journal-title":"Front Pediatr"},{"issue":"01","key":"ref64","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1542\/peds.2007-0925","article-title":"Impact of patent ductus arteriosus and subsequent therapy with indomethacin on cerebral oxygenation in preterm infants","volume":"121","author":"P M Lemmers","year":"2008","journal-title":"Pediatrics"},{"issue":"08","key":"ref65","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1007\/s00246-012-0309-5","article-title":"Does treatment of patent ductus arteriosus with cyclooxygenase inhibitors affect neonatal regional tissue oxygenation?","volume":"33","author":"M Bhatt","year":"2012","journal-title":"Pediatr Cardiol"},{"issue":"04","key":"ref66","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1097\/MPG.0000000000002420","article-title":"Effect of patent ductus arteriosus on splanchnic oxygenation at enteral feeding introduction in very preterm infants","volume":"69","author":"S Martini","year":"2019","journal-title":"J Pediatr Gastroenterol Nutr"},{"issue":"03","key":"ref67","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1080\/14767058.2018.1490719","article-title":"Preterm infant gut microbial patterns related to the development of necrotizing enterocolitis","volume":"33","author":"T P Lindberg","year":"2020","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"01","key":"ref68","doi-asserted-by":"crossref","first-page":"12104","DOI":"10.1038\/s41598-025-95198-1","article-title":"Progression of gut microbiome in preterm infants during the first three months","volume":"15","author":"F Li","year":"2025","journal-title":"Sci Rep"},{"issue":"09","key":"ref69","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.3390\/biom12091179","article-title":"The patent ductus arteriosus in extremely preterm neonates is more than a hemodynamic challenge: new molecular insights","volume":"12","author":"A Sellmer","year":"2022","journal-title":"Biomolecules"},{"issue":"06","key":"ref70","doi-asserted-by":"crossref","first-page":"835","DOI":"10.21037\/tp-20-121","article-title":"Patent ductus arteriosus and oxidative stress in preterm infants: a narrative review","volume":"9","author":"C Dani","year":"2020","journal-title":"Transl Pediatr"},{"issue":"02","key":"ref71","first-page":"184","article-title":"Patent ductus arteriosus, indomethacin and necrotizing enterocolitis in very low birth weight infants: a population-based study","volume":"40","author":"S Dollberg","year":"2005","journal-title":"J Pediatr Gastroenterol Nutr"},{"issue":"11","key":"ref72","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1056\/NEJMoa2207418","article-title":"Expectant management or early ibuprofen for patent ductus arteriosus","volume":"388","author":"T Hundscheid","year":"2023","journal-title":"N Engl J 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Hammerman","year":"2008","journal-title":"Pediatr Res"},{"issue":"05","key":"ref76","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1016\/S0022-3476(99)70239-8","article-title":"Short versus prolonged indomethacin therapy for patent ductus arteriosus in preterm infants","volume":"134","author":"O Tammela","year":"1999","journal-title":"J Pediatr"},{"issue":"05","key":"ref77","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1007\/BF00441971","article-title":"Effects of prolonged versus acute indomethacin therapy in very low birth-weight infants with patent ductus arteriosus","volume":"147","author":"P G Rhodes","year":"1988","journal-title":"Eur J Pediatr"},{"issue":"07","key":"ref78","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1007\/s13312-015-0677-z","article-title":"Enteral paracetamol or intravenous indomethacin for closure of patent ductus arteriosus in preterm neonates: a randomized controlled trial","volume":"52","author":"S K Dash","year":"2015","journal-title":"Indian Pediatr"},{"issue":"S 03","key":"ref79","first-page":"S563","article-title":"A comparison of oral ibuprofen and intravenous indomethacin for closure of patent ductus arteriosus in preterm infants","volume":"86","author":"U Chotigeat","year":"2003","journal-title":"J Med Assoc Thai"},{"issue":"02","key":"ref80","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1067\/mpd.2001.110528","article-title":"Early versus late indomethacin treatment for patent ductus arteriosus in premature infants with respiratory distress syndrome","volume":"138","author":"B Van Overmeire","year":"2001","journal-title":"J Pediatr"},{"issue":"03","key":"ref81","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1097\/00000658-199609000-00011","article-title":"Increased risk of necrotizing enterocolitis in premature infants with patent ductus arteriosus treated with indomethacin","volume":"224","author":"J L Grosfeld","year":"1996","journal-title":"Ann Surg"},{"issue":"12","key":"ref82","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1016\/S0022-3468(87)80730-3","article-title":"Management of patent ductus arteriosus: a comparison of operative v pharmacologic treatment","volume":"22","author":"S B Palder","year":"1987","journal-title":"J Pediatr Surg"},{"issue":"01","key":"ref83","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.jpedsurg.2008.10.019","article-title":"Analysis of outcome in 298 extremely low-birth-weight infants with patent ductus arteriosus","volume":"44","author":"F Alexander","year":"2009","journal-title":"J Pediatr Surg"},{"issue":"07","key":"ref84","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1038\/sj.jp.7210795","article-title":"Neonatal necrotizing enterocolitis with intestinal perforation in extremely premature infants receiving early indomethacin treatment for patent ductus arteriosus","volume":"22","author":"A M Fujii","year":"2002","journal-title":"J 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Watering","year":"2024","journal-title":"Animals (Basel)"},{"issue":"01","key":"ref97","doi-asserted-by":"crossref","first-page":"177","DOI":"10.5005\/jp-journals-11002-0001","article-title":"Role of near-infrared spectroscopy in the diagnosis and assessment of necrotizing enterocolitis","volume":"1","author":"V Mishra","year":"2022","journal-title":"Newborn (Clarksville)"},{"issue":"06","key":"ref98","doi-asserted-by":"crossref","first-page":"e0125437","DOI":"10.1371\/journal.pone.0125437","article-title":"Low abdominal NIRS values and elevated plasma intestinal fatty acid-binding protein in a premature piglet model of necrotizing enterocolitis","volume":"10","author":"I J Zamora","year":"2015","journal-title":"PLoS One"},{"issue":"05","key":"ref99","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1038\/s41372-018-0075-1","article-title":"Splanchnic NIRS monitoring in neonatal care: rationale, current applications and future perspectives","volume":"38","author":"S 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