Feasibility of Continuous Multi-Site Skin Temperature Monitoring for Early Detection of Necrotizing Enterocolitis in Preterm Infants

Feasibility of Continuous Multi-Site Skin Temperature Monitoring for Early Detection of Necrotizing Enterocolitis in Preterm Infants | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Feasibility of Continuous Multi-Site Skin Temperature Monitoring for Early Detection of Necrotizing Enterocolitis in Preterm Infants Huan-Shiu Chen, Teh-Ming Wang, Chuang-Chien Chiu, Hsin-Hung Kuo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9189429/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Necrotizing enterocolitis (NEC) is a critical gastrointestinal disease in preterm infants and a leading cause of morbidity and mortality in neonatal intensive care units. Early identification is essential to prevent severe complications; however, diagnosis remains challenging due to nonspecific early symptoms. This study aimed to evaluate the feasibility of continuous non-invasive multi-site skin temperature monitoring for early assessment of suspected NEC in preterm infants. Methods A prospective observational pilot study was conducted in a neonatal intensive care unit. Preterm infants (gestational age < 37 weeks) clinically suspected of early-stage NEC were enrolled. Continuous skin temperature measurements were obtained at three anatomical sites—central abdomen, dorsum of the hand, and dorsum of the foot—using a precision digital thermometer (TM-907A) over a standardized 20-minute monitoring period. Data were recorded and analyzed using a custom LabVIEW-based platform. A total of 16 preterm infants were included in the analysis. Results Continuous multi-site skin temperature monitoring was successfully implemented in all 16 participants without interruption, demonstrating the technical feasibility of real-time physiological data acquisition in a NICU setting. Temperature variations across the three anatomical sites were minimal and did not demonstrate clear differentiation among subjects during the monitoring period. No consistent or distinct temperature patterns were observed, and environmental parameters such as incubator temperature and humidity showed no clear associations with the recorded signals. These findings suggest that temperature-based monitoring alone may have limited sensitivity for early NEC detection, particularly in mild or early-stage cases. Conclusions This study confirms the feasibility of continuous non-invasive multi-site physiological monitoring in a neonatal intensive care setting. However, skin temperature monitoring alone did not provide sufficient sensitivity for early NEC detection in this cohort. These preliminary findings highlight the need to integrate additional physiological parameters and multi-modal monitoring approaches to improve diagnostic sensitivity and support the development of data-driven early NEC assessment strategies in preterm infants. Necrotizing enterocolitis Preterm infants Non-invasive monitoring Skin temperature Physiological monitoring Neonatal intensive care Figures Figure 1 Figure 2 Figure 3 Figure 4 INTRODUCTION Necrotizing enterocolitis (NEC) is a critical gastrointestinal disease in preterm infants and remains a leading cause of morbidity and mortality in neonatal intensive care units [ 9 – 12 ]. Early identification is essential to prevent severe complications, yet diagnosis remains challenging due to nonspecific early symptoms [ 10 , 12 ]. Previous studies have explored physiological indicators, including perfusion-related parameters and thermal regulation, to assess neonatal circulatory status and detect early abnormalities [ 1 , 2 , 3 , 4 ]. The clinical diagnosis of NEC relies primarily on radiographic and laboratory findings; however, these indicators often become evident only after disease progression, limiting their utility for early intervention [ 9 , 10 ]. The Bell staging criteria, widely used in clinical practice, classify NEC severity into three stages, yet distinguishing stage I (suspected NEC) from other gastrointestinal conditions in preterm infants remains clinically challenging [ 12 ]. Current monitoring approaches in the NICU, including serial abdominal examinations and standard vital signs, may lack the sensitivity required to detect subtle early physiological changes associated with NEC onset [ 11 , 13 ]. Peripheral skin temperature has been studied as a surrogate marker for circulatory status and peripheral perfusion in neonates. Alterations in skin temperature across body sites may reflect changes in vasomotor tone and peripheral blood flow redistribution, which are early responses to hemodynamic compromise [ 3 , 4 ]. Studies in preterm infants have demonstrated that temperature gradients between central and peripheral sites can reflect autonomic and thermoregulatory responses, though these responses are subject to considerable variability depending on gestational age, environmental conditions, and clinical status [ 3 , 7 , 22 ]. Non-invasive temperature monitoring has been proposed as a practical tool for continuous bedside assessment, given its safety and ease of use in the fragile neonatal population [ 23 ]. Despite growing interest in physiological monitoring for NEC detection, most existing approaches rely on single-parameter assessment or episodic measurements that may fail to capture the dynamic and transient nature of early NEC. Continuous multi-site monitoring, which simultaneously records temperature at several anatomical locations over a sustained period, may offer greater sensitivity by capturing temporal trends and inter-site gradients [ 1 , 2 , 14 , 15 ]. However, the practical feasibility of implementing such a monitoring system within a real NICU environment, and its clinical discriminatory value in early NEC, has not been well established. Therefore, this study aimed to evaluate the feasibility of continuous non-invasive multi-site skin temperature monitoring as a tool for early assessment of suspected NEC in preterm infants admitted to the NICU, and to assess whether temperature-based parameters provide sufficient physiological differentiation to support clinical decision-making in this population. METHODS Study Design and Participants This study was designed as a prospective observational pilot study conducted in a neonatal intensive care unit. Preterm infants (gestational age < 37 weeks) who were clinically suspected of having early-stage necrotizing enterocolitis (NEC) by attending physicians were eligible for inclusion. Exclusion criteria included severe congenital anomalies, congenital heart disease, severe infection, grade III or higher intraventricular hemorrhage, periventricular leukomalacia, requirement for surgical intervention, or end-of-life care status. Written informed consent was obtained from parents or legal guardians prior to participation. The baseline demographic and clinical characteristics of the study participants are summarized in Table 1 . Table 1 Basic Characteristics of Preterm Infants (n = 16). Variable Min Max Mean ± SD Gestational age (weeks) 25 37 31.67 ± 3.21 Birth weight (g) 530 2125 1153.13 ± 329.24 APGAR score (1 minute) 1 7 4.27 ± 2.09 APGAR score (5 minutes) 2 8 6.80 ± 1.66 Physiological Monitoring System A non-invasive monitoring system was developed to continuously record physiological parameters. Skin temperature was measured at multiple anatomical sites, including the central abdomen, dorsum of the hand, and dorsum of the foot, using a precision digital thermometer (TM-907A), as shown in Fig. 1 . Data were transmitted via RS-232 interface and recorded using a custom LabVIEW-based platform. The system enabled real-time acquisition, visualization, and storage of physiological data. Measurements were collected over a standardized monitoring period and stored for subsequent analysis. Experiment Architecture The measurement workflow of the assessment system for detecting necrotizing enterocolitis (NEC) in preterm infants is as follows. When a preterm infant was clinically evaluated by a physician as having suspected NEC, four-point skin temperature sensors were immediately applied to predefined anatomical sites, including the central abdomen, dorsum of the hand, and dorsum of the foot. Temperature measurements were recorded over a fixed monitoring period of 20 minutes. The system architecture consisted of a custom-developed LABVIEW-based monitoring platform, which transmitted physiological data to a personal computer via RS-232 serial communication. All acquired data were continuously stored and archived on the computer for long-term recording. Subsequently, computational processing and data analysis were performed using programs developed within the LABVIEW environment, and the processed results were displayed in real time through a graphical user interface. Measurement Equipment A precision digital thermometer (TM-907A) was used for temperature measurements in this study. The device features a four-and-a-half-digit display with a maximum reading of 19,999 and supports temperature measurements in both Celsius and Fahrenheit units. It provides a resolution of 0.01°C/0.1°C (or 0.01°F/0.1°F) and includes a data-hold function. Measurement accuracy is ±(0.1% + 0.2°C) for temperatures below 200°C and ±(0.15% + 0.5°C) for temperatures at or above 200°C, with an approximate sampling time of 0.4 seconds. The measurement range extends from − 199.99°C to 800.0°C. The device is equipped with RS-232 and USB communication interfaces to facilitate long-term data transmission and storage. Software Development A real-time monitoring system was developed using the LabVIEW graphical programming environment. Data transmission was achieved via RS-232 communication, enabling seamless integration of measurement hardware with software-based signal processing and data analysis modules. The LabVIEW platform provides built-in signal processing libraries and supports the development of customized graphical user interfaces, allowing clinicians to efficiently visualize and interpret physiological signals. The system offers high sensitivity for detecting subtle physiological changes, delivers accurate numerical measurements, supports high-resolution acquisition of physiological parameters and waveforms, and enables long-term continuous recording with data storage. In addition, real-time waveform displays and physiological parameter reports were updated at five-second intervals to enhance clinical monitoring and interpretation. Data Collection Physiological data, including multi-site skin temperature, were continuously recorded during bedside monitoring. Environmental conditions, including incubator temperature and humidity, were also monitored to account for potential confounding effects. Basic demographic and clinical information, including gestational age, birth weight, and Apgar scores, were collected for all participants. Additional clinical data recorded for each enrolled infant included recent clinical diagnoses and ongoing medical or nursing interventions during the study period. All measurements were synchronously transmitted to and stored on the study computer via the TM-907A device interface for subsequent analysis. Statistical Analysis Descriptive statistics were used to summarize physiological parameters, including mean and standard deviation. Due to the exploratory nature of this pilot study and the limited sample size, formal inferential statistical testing was not emphasized. Trends in temperature variations across anatomical sites were visually and descriptively analyzed. Future studies with larger sample sizes are required to enable more robust statistical comparisons and model-based analysis. RESULTS A total of 16 preterm infants clinically suspected of NEC were included in the analysis. Most cases were classified as early-stage (stage I–II), with only one case progressing to stage III disease. Continuous physiological monitoring was successfully implemented in all participants, demonstrating the feasibility of real-time, non-invasive data acquisition in a NICU setting. Continuous multi-site skin temperature measurements were successfully acquired without interruption, and all physiological data were reliably recorded and stored for subsequent analysis, as illustrated in Figs. 2 – 4 . Analysis of temperature data showed that variations across anatomical sites, including the abdomen, hand, and foot, were minimal during the monitoring period. No consistent or distinct temperature patterns were observed among subjects. Additionally, environmental parameters, such as incubator temperature and humidity, did not demonstrate clear associations with the recorded physiological signals. Overall, the findings indicate that temperature-based measurements alone did not provide sufficient differentiation for identifying early-stage NEC in this cohort. The limited variability observed may be attributable to the relatively mild disease severity and small sample size. Discussion This study explored the feasibility of using multi-site skin temperature monitoring for early NEC assessment in preterm infants. Contrary to expectations, temperature variations across measurement sites did not demonstrate clear or consistent patterns during the early stage of suspected NEC. One possible explanation is that most enrolled cases were classified as mild (stage I–II), where physiological changes may not yet be sufficiently pronounced to produce detectable temperature differences. Previous studies have shown that physiological signals in preterm infants can be highly variable and influenced by developmental status and environmental factors [ 17 , 18 , 22 ]. This finding suggests that temperature alone may lack sensitivity as an early biomarker for NEC. Importantly, these results provide valuable insight into the limitations of single-parameter monitoring approaches. While temperature monitoring is non-invasive and clinically convenient, it may not adequately capture the complex physiological changes associated with early NEC. Prior studies have emphasized that peripheral perfusion and hemodynamic responses are multifactorial and may not be fully reflected by a single physiological parameter [ 20 , 21 ]. The technical feasibility demonstrated here is consistent with previous reports of continuous physiological monitoring in NICU settings [ 6 ]. However, the limited discriminatory value of temperature alone aligns with prior work emphasizing that peripheral perfusion and hemodynamic responses to early gut injury are multifactorial and unlikely to be fully captured by a single parameter [ 20 , 21 ]. Studies incorporating perfusion index alongside temperature have reported greater sensitivity for detecting circulatory instability in preterm infants [ 1 , 16 , 19 ], suggesting that a composite approach may be necessary. Furthermore, multi-modal monitoring integrating cardiovascular and autonomic indicators, such as heart rate variability, has shown promise for characterizing neonatal physiological stability and may complement temperature-based assessment [ 27 , 28 ]. Future research should focus on multi-modal monitoring strategies and larger cohorts, particularly including more severe NEC cases, to better characterize physiological patterns and improve early diagnostic capabilities. In addition, clinical care strategies such as kangaroo care and supportive developmental interventions may further influence physiological regulation and should be considered in future investigations [ 24 – 26 , 29 , 30 ]. Conclusion This pilot study confirms the technical feasibility of continuous non-invasive multi-site skin temperature monitoring in the NICU, but demonstrates that temperature-based assessment alone provides insufficient sensitivity for early NEC detection, particularly in mild disease. These findings support the development of multi-modal monitoring strategies incorporating additional physiological parameters, and underscore the need for larger prospective studies including more severe NEC cases to validate and refine this approach. Declarations Acknowledgements The authors gratefully acknowledge the support of Taichung Veterans General Hospital and Feng Chia University for providing resources for this research project. Special thanks are extended to Dr. Te-Ming Wang for his valuable clinical guidance and professional expertise throughout the study. Human Ethics and Consent to Participate This study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board (IRB) of Taichung Veterans General Hospital (IRB No. SF17169B). Written informed consent was obtained from the parents or legal guardians of all participants prior to enrollment. Funding This research was supported by institutional resources from Taichung Veterans General Hospital and Feng Chia University (Funding Number: TCVGH-FCU1068204). Conflict-of-interest statement: There are no conflicts of interest to report. References Cresi F, Pelle E, Calabrese R, Costa L, Farinasso D, Silvestro L. Perfusion index variations in clinically and hemodynamically stable preterm newborns in the first week of life. Ital J Pediatr. 2010;36:1. Granelli A, Ostman-Smith I. Noninvasive peripheral perfusion index as a possible tool for screening for critical left heart obstruction. Acta Paediatr. 2007;96:1455–9. Lyon A, Pikaar M, Badger P, McIntosh N. Temperature control in very low birthweight infants during first five days of life. Arch Dis Child Fetal Neonatal Ed. 1997;76:F47–50. Miller S, Lee H, Gould J. Hypothermia in very low birth weight infants: distribution, risk factors and outcomes. J Perinatol. 2011;31:S49–56. Knobel RB, Holditch-Davis D, Schwartz TA, Wimmer JE Jr. Extremely low birth weight preterm infants lack vasomotor response in relationship to cold body temperatures at birth. J Perinatol. 2009;29:814–21. Moorman JR, Lake DE, Ivanova I, Delos JB, Fairchild KD, Kattwinkel J et al. Monitoring technologies in the neonatal intensive care unit: implications for the detection of necrotizing enterocolitis. J Perinatol. 2010;30 Suppl:S10-6. Adams AK, Nelson RA, Bell EF, Egoavil CA. Use of infrared thermographic calorimetry to determine energy expenditure in preterm infants. Am J Clin Nutr. 2000;71:969–77. Ek JR, Bell EF, Nelson RA, Radhi MA. Infrared thermographic calorimetry applied to preterm infants under radiant warmers. J Therm Biol. 1999;24:97–103. Neu J, Walker WA. Necrotizing enterocolitis. N Engl J Med. 2011;364:255–64. Niño DF, Sodhi CP, Hackam DJ. Necrotizing enterocolitis: new insights into pathogenesis and mechanisms. Nat Rev Gastroenterol Hepatol. 2016;13:590–600. Fitzgibbons SC, Ching Y, Yu D, Carpenter J, Kenny M, Weldon C, Lillehei CW, Valim C, Horbar JD, Jaksic T. Mortality of necrotizing enterocolitis expressed by birth weight categories. J Pediatr Surg. 2009;44:1072–6. Gordon PV, Swanson JR, Clark R, Spitzer AR. The changing pattern of necrotizing enterocolitis. J Perinatol. 2007;27:9–13. Patel RM, Denning PW. Therapeutic use of prebiotics, probiotics, and postbiotics to prevent necrotizing enterocolitis: what is the current evidence? Clin Perinatol. 2013;40:11–25. Underwood MA. Human milk for the premature infant. Pediatr Clin North Am. 2013;60:189–207. Laughon M, Bose C, Allred EN, O’Shea TM, Van Marter LJ, Ehrenkranz RA, Leviton A. Patterns of illness in extremely preterm infants. Am J Obstet Gynecol. 2009;201:e5001–8. Mintzer JP, Parvez B, Chelala M, Alpan G. Impact of sepsis on perfusion index in neonates. J Perinatol. 2014;34:480–4. Sahni R, Schulze KF, Kashyap S, Ohira-Kist K, Fifer WP, Myers MM. Body position, sleep states, and cardiorespiratory activity in developing low birth weight infants. Early Hum Dev. 1999;54:197–206. van Vonderen JJ, Roest AA, Siew ML, Walther FJ, Hooper SB, te, Pas AB. Measuring physiological changes during the transition to life after birth. Neonatology. 2014;105:230 – 42. Dani C, Pratesi S, Fontanelli G, Barp J, Bertini G. Blood perfusion index in preterm infants during the first week of life. Early Hum Dev. 2010;86:273–6. Lima A, Bakker J. Noninvasive monitoring of peripheral perfusion. Intensive Care Med. 2005;31:1316–26. El-Khuffash A, Molloy EJ. Are hemodynamic biomarkers useful in neonatal care? Pediatr Res. 2008;64:236–40. Huizing MJ, Villamor E. Temperature regulation in preterm infants: a review. J Perinatol. 2019;39:1131–9. Knobel RB, Holditch-Davis D, Schwartz TA. Optimal body temperature in transitional extremely low birth weight infants using heart rate and temperature as indicators. J Obstet Gynecol Neonatal Nurs. 2010;39:3–14. Karlsson V, Heinemann AB, Sjörs G, Nykvist KH, Ågren J. Early skin-to-skin care in extremely preterm infants. Acta Paediatr. 2012;101:1002–7. Bergman NJ, Linley LL, Fawcus SR. Randomized controlled trial of skin-to-skin contact from birth. Acta Paediatr. 2004;93:779–85. Boundy EO, Dastjerdi R, Spiegelman D, Fawzi WW, Missmer SA, Lieberman E, Kajeepeta S, Wall S, Chan GJ. Kangaroo mother care and neonatal outcomes: a meta-analysis. Pediatrics. 2016;137:e20152238. Kommers DR, Joshi R, van Pul C, Feijs L, Oei G, Oetomo SB, Andriessen P. Features of heart rate variability capture regulatory changes during kangaroo care in preterm infants. J Pediatr. 2017;182:92–8. Tian Y, Inocencio IM, Wong FY. Impact of kangaroo mother care on autonomic cardiovascular control in preterm infants. Pediatr Res. 2025;97:1983–8. Schulzke SM, Deshpande GC, Patole SK. Neurodevelopmental outcomes of very low birth weight infants. Arch Dis Child. 2007;92:F423–8. Gregory KE, Deforge CE, Natale KM, Phillips M, Van Marter LJ. Necrotizing enterocolitis in the premature infant. Adv Neonatal Care. 2011;11:155–64. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 30 Apr, 2026 Reviewers agreed at journal 25 Apr, 2026 Reviews received at journal 24 Apr, 2026 Reviewers agreed at journal 24 Apr, 2026 Reviewers invited by journal 23 Apr, 2026 Editor invited by journal 02 Apr, 2026 Editor assigned by journal 01 Apr, 2026 Submission checks completed at journal 01 Apr, 2026 First submitted to journal 22 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9189429","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":633729741,"identity":"08b71753-0d15-4ab2-a8f8-f66a60588598","order_by":0,"name":"Huan-Shiu Chen","email":"","orcid":"","institution":"Feng Chia University","correspondingAuthor":false,"prefix":"","firstName":"Huan-Shiu","middleName":"","lastName":"Chen","suffix":""},{"id":633729742,"identity":"376143ec-abb0-4d3a-9d17-d75cd0cbe509","order_by":1,"name":"Teh-Ming Wang","email":"","orcid":"","institution":"Taichung Veterans General 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17:32:09","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":259131,"visible":true,"origin":"","legend":"\u003cp\u003eMeasuring an infant's hand temperature.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9189429/v1/8961202b7ba894a7a517474b.png"},{"id":108806552,"identity":"8bd9aa1b-b32d-41f2-befb-fc2bca580281","added_by":"auto","created_at":"2026-05-08 15:28:54","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":130486,"visible":true,"origin":"","legend":"\u003cp\u003eMeasuring an infant's abdominal temperature.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-9189429/v1/2c7dbc1acf96b56885b9f878.png"},{"id":108807041,"identity":"e64390f3-e474-4157-a2b9-25ef9d9251d5","added_by":"auto","created_at":"2026-05-08 15:29:59","extension":"png","order_by":4,"title":"Figure 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Infants","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eNecrotizing enterocolitis (NEC) is a critical gastrointestinal disease in preterm infants and remains a leading cause of morbidity and mortality in neonatal intensive care units [\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Early identification is essential to prevent severe complications, yet diagnosis remains challenging due to nonspecific early symptoms [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Previous studies have explored physiological indicators, including perfusion-related parameters and thermal regulation, to assess neonatal circulatory status and detect early abnormalities [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe clinical diagnosis of NEC relies primarily on radiographic and laboratory findings; however, these indicators often become evident only after disease progression, limiting their utility for early intervention [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The Bell staging criteria, widely used in clinical practice, classify NEC severity into three stages, yet distinguishing stage I (suspected NEC) from other gastrointestinal conditions in preterm infants remains clinically challenging [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Current monitoring approaches in the NICU, including serial abdominal examinations and standard vital signs, may lack the sensitivity required to detect subtle early physiological changes associated with NEC onset [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePeripheral skin temperature has been studied as a surrogate marker for circulatory status and peripheral perfusion in neonates. Alterations in skin temperature across body sites may reflect changes in vasomotor tone and peripheral blood flow redistribution, which are early responses to hemodynamic compromise [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Studies in preterm infants have demonstrated that temperature gradients between central and peripheral sites can reflect autonomic and thermoregulatory responses, though these responses are subject to considerable variability depending on gestational age, environmental conditions, and clinical status [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Non-invasive temperature monitoring has been proposed as a practical tool for continuous bedside assessment, given its safety and ease of use in the fragile neonatal population [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite growing interest in physiological monitoring for NEC detection, most existing approaches rely on single-parameter assessment or episodic measurements that may fail to capture the dynamic and transient nature of early NEC. Continuous multi-site monitoring, which simultaneously records temperature at several anatomical locations over a sustained period, may offer greater sensitivity by capturing temporal trends and inter-site gradients [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. However, the practical feasibility of implementing such a monitoring system within a real NICU environment, and its clinical discriminatory value in early NEC, has not been well established.\u003c/p\u003e \u003cp\u003eTherefore, this study aimed to evaluate the feasibility of continuous non-invasive multi-site skin temperature monitoring as a tool for early assessment of suspected NEC in preterm infants admitted to the NICU, and to assess whether temperature-based parameters provide sufficient physiological differentiation to support clinical decision-making in this population.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eStudy Design and Participants\u003c/p\u003e \u003cp\u003eThis study was designed as a prospective observational pilot study conducted in a neonatal intensive care unit. Preterm infants (gestational age\u0026thinsp;\u0026lt;\u0026thinsp;37 weeks) who were clinically suspected of having early-stage necrotizing enterocolitis (NEC) by attending physicians were eligible for inclusion. Exclusion criteria included severe congenital anomalies, congenital heart disease, severe infection, grade III or higher intraventricular hemorrhage, periventricular leukomalacia, requirement for surgical intervention, or end-of-life care status. Written informed consent was obtained from parents or legal guardians prior to participation. The baseline demographic and clinical characteristics of the study participants are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBasic Characteristics of Preterm Infants (n\u0026thinsp;=\u0026thinsp;16).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMin\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMax\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational age (weeks)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e31.67\u0026thinsp;\u0026plusmn;\u0026thinsp;3.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth weight (g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e530\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e1153.13\u0026thinsp;\u0026plusmn;\u0026thinsp;329.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAPGAR score (1 minute)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e4.27\u0026thinsp;\u0026plusmn;\u0026thinsp;2.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAPGAR score (5 minutes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e6.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePhysiological Monitoring System\u003c/p\u003e \u003cp\u003eA non-invasive monitoring system was developed to continuously record physiological parameters. Skin temperature was measured at multiple anatomical sites, including the central abdomen, dorsum of the hand, and dorsum of the foot, using a precision digital thermometer (TM-907A), as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Data were transmitted via RS-232 interface and recorded using a custom LabVIEW-based platform.\u003c/p\u003e \u003cp\u003eThe system enabled real-time acquisition, visualization, and storage of physiological data. Measurements were collected over a standardized monitoring period and stored for subsequent analysis.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eExperiment Architecture\u003c/p\u003e \u003cp\u003eThe measurement workflow of the assessment system for detecting necrotizing enterocolitis (NEC) in preterm infants is as follows. When a preterm infant was clinically evaluated by a physician as having suspected NEC, four-point skin temperature sensors were immediately applied to predefined anatomical sites, including the central abdomen, dorsum of the hand, and dorsum of the foot. Temperature measurements were recorded over a fixed monitoring period of 20 minutes.\u003c/p\u003e \u003cp\u003eThe system architecture consisted of a custom-developed LABVIEW-based monitoring platform, which transmitted physiological data to a personal computer via RS-232 serial communication. All acquired data were continuously stored and archived on the computer for long-term recording. Subsequently, computational processing and data analysis were performed using programs developed within the LABVIEW environment, and the processed results were displayed in real time through a graphical user interface.\u003c/p\u003e \u003cp\u003eMeasurement Equipment\u003c/p\u003e \u003cp\u003eA precision digital thermometer (TM-907A) was used for temperature measurements in this study. The device features a four-and-a-half-digit display with a maximum reading of 19,999 and supports temperature measurements in both Celsius and Fahrenheit units. It provides a resolution of 0.01\u0026deg;C/0.1\u0026deg;C (or 0.01\u0026deg;F/0.1\u0026deg;F) and includes a data-hold function. Measurement accuracy is \u0026plusmn;(0.1% + 0.2\u0026deg;C) for temperatures below 200\u0026deg;C and \u0026plusmn;(0.15% + 0.5\u0026deg;C) for temperatures at or above 200\u0026deg;C, with an approximate sampling time of 0.4 seconds. The measurement range extends from \u0026minus;\u0026thinsp;199.99\u0026deg;C to 800.0\u0026deg;C. The device is equipped with RS-232 and USB communication interfaces to facilitate long-term data transmission and storage.\u003c/p\u003e \u003cp\u003eSoftware Development\u003c/p\u003e \u003cp\u003eA real-time monitoring system was developed using the LabVIEW graphical programming environment. Data transmission was achieved via RS-232 communication, enabling seamless integration of measurement hardware with software-based signal processing and data analysis modules. The LabVIEW platform provides built-in signal processing libraries and supports the development of customized graphical user interfaces, allowing clinicians to efficiently visualize and interpret physiological signals. The system offers high sensitivity for detecting subtle physiological changes, delivers accurate numerical measurements, supports high-resolution acquisition of physiological parameters and waveforms, and enables long-term continuous recording with data storage. In addition, real-time waveform displays and physiological parameter reports were updated at five-second intervals to enhance clinical monitoring and interpretation.\u003c/p\u003e \u003cp\u003eData Collection\u003c/p\u003e \u003cp\u003ePhysiological data, including multi-site skin temperature, were continuously recorded during bedside monitoring. Environmental conditions, including incubator temperature and humidity, were also monitored to account for potential confounding effects. Basic demographic and clinical information, including gestational age, birth weight, and Apgar scores, were collected for all participants. Additional clinical data recorded for each enrolled infant included recent clinical diagnoses and ongoing medical or nursing interventions during the study period. All measurements were synchronously transmitted to and stored on the study computer via the TM-907A device interface for subsequent analysis.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were used to summarize physiological parameters, including mean and standard deviation. Due to the exploratory nature of this pilot study and the limited sample size, formal inferential statistical testing was not emphasized. Trends in temperature variations across anatomical sites were visually and descriptively analyzed. Future studies with larger sample sizes are required to enable more robust statistical comparisons and model-based analysis.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 16 preterm infants clinically suspected of NEC were included in the analysis. Most cases were classified as early-stage (stage I\u0026ndash;II), with only one case progressing to stage III disease.\u003c/p\u003e \u003cp\u003eContinuous physiological monitoring was successfully implemented in all participants, demonstrating the feasibility of real-time, non-invasive data acquisition in a NICU setting. Continuous multi-site skin temperature measurements were successfully acquired without interruption, and all physiological data were reliably recorded and stored for subsequent analysis, as illustrated in Figs.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eAnalysis of temperature data showed that variations across anatomical sites, including the abdomen, hand, and foot, were minimal during the monitoring period. No consistent or distinct temperature patterns were observed among subjects. Additionally, environmental parameters, such as incubator temperature and humidity, did not demonstrate clear associations with the recorded physiological signals.\u003c/p\u003e \u003cp\u003eOverall, the findings indicate that temperature-based measurements alone did not provide sufficient differentiation for identifying early-stage NEC in this cohort. The limited variability observed may be attributable to the relatively mild disease severity and small sample size.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explored the feasibility of using multi-site skin temperature monitoring for early NEC assessment in preterm infants. Contrary to expectations, temperature variations across measurement sites did not demonstrate clear or consistent patterns during the early stage of suspected NEC.\u003c/p\u003e \u003cp\u003eOne possible explanation is that most enrolled cases were classified as mild (stage I\u0026ndash;II), where physiological changes may not yet be sufficiently pronounced to produce detectable temperature differences. Previous studies have shown that physiological signals in preterm infants can be highly variable and influenced by developmental status and environmental factors [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. This finding suggests that temperature alone may lack sensitivity as an early biomarker for NEC.\u003c/p\u003e \u003cp\u003eImportantly, these results provide valuable insight into the limitations of single-parameter monitoring approaches. While temperature monitoring is non-invasive and clinically convenient, it may not adequately capture the complex physiological changes associated with early NEC. Prior studies have emphasized that peripheral perfusion and hemodynamic responses are multifactorial and may not be fully reflected by a single physiological parameter [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe technical feasibility demonstrated here is consistent with previous reports of continuous physiological monitoring in NICU settings [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, the limited discriminatory value of temperature alone aligns with prior work emphasizing that peripheral perfusion and hemodynamic responses to early gut injury are multifactorial and unlikely to be fully captured by a single parameter [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Studies incorporating perfusion index alongside temperature have reported greater sensitivity for detecting circulatory instability in preterm infants [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], suggesting that a composite approach may be necessary. Furthermore, multi-modal monitoring integrating cardiovascular and autonomic indicators, such as heart rate variability, has shown promise for characterizing neonatal physiological stability and may complement temperature-based assessment [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFuture research should focus on multi-modal monitoring strategies and larger cohorts, particularly including more severe NEC cases, to better characterize physiological patterns and improve early diagnostic capabilities. In addition, clinical care strategies such as kangaroo care and supportive developmental interventions may further influence physiological regulation and should be considered in future investigations [\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis pilot study confirms the technical feasibility of continuous non-invasive multi-site skin temperature monitoring in the NICU, but demonstrates that temperature-based assessment alone provides insufficient sensitivity for early NEC detection, particularly in mild disease. These findings support the development of multi-modal monitoring strategies incorporating additional physiological parameters, and underscore the need for larger prospective studies including more severe NEC cases to validate and refine this approach.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe authors gratefully acknowledge the support of Taichung Veterans General Hospital and Feng Chia University for providing resources for this research project. Special thanks are extended to Dr. Te-Ming Wang for his valuable clinical guidance and professional expertise throughout the study.\u003c/p\u003e\n\u003cp\u003eHuman Ethics and Consent to Participate\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board (IRB) of Taichung Veterans General Hospital (IRB No. SF17169B). Written informed consent was obtained from the parents or legal guardians of all participants prior to enrollment.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis research was supported by institutional resources from Taichung Veterans General Hospital and Feng Chia University (Funding Number: TCVGH-FCU1068204).\u003c/p\u003e\n\u003cp\u003eConflict-of-interest statement:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere are no conflicts of interest to report.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCresi F, Pelle E, Calabrese R, Costa L, Farinasso D, Silvestro L. Perfusion index variations in clinically and hemodynamically stable preterm newborns in the first week of life. Ital J Pediatr. 2010;36:1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGranelli A, Ostman-Smith I. Noninvasive peripheral perfusion index as a possible tool for screening for critical left heart obstruction. 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Neonatology. 2014;105:230\u0026thinsp;\u0026ndash;\u0026thinsp;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDani C, Pratesi S, Fontanelli G, Barp J, Bertini G. Blood perfusion index in preterm infants during the first week of life. Early Hum Dev. 2010;86:273\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLima A, Bakker J. Noninvasive monitoring of peripheral perfusion. Intensive Care Med. 2005;31:1316\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl-Khuffash A, Molloy EJ. Are hemodynamic biomarkers useful in neonatal care? Pediatr Res. 2008;64:236\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuizing MJ, Villamor E. Temperature regulation in preterm infants: a review. J Perinatol. 2019;39:1131\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKnobel RB, Holditch-Davis D, Schwartz TA. Optimal body temperature in transitional extremely low birth weight infants using heart rate and temperature as indicators. J Obstet Gynecol Neonatal Nurs. 2010;39:3\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKarlsson V, Heinemann AB, Sj\u0026ouml;rs G, Nykvist KH, \u0026Aring;gren J. Early skin-to-skin care in extremely preterm infants. Acta Paediatr. 2012;101:1002\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBergman NJ, Linley LL, Fawcus SR. Randomized controlled trial of skin-to-skin contact from birth. Acta Paediatr. 2004;93:779\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoundy EO, Dastjerdi R, Spiegelman D, Fawzi WW, Missmer SA, Lieberman E, Kajeepeta S, Wall S, Chan GJ. Kangaroo mother care and neonatal outcomes: a meta-analysis. Pediatrics. 2016;137:e20152238.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKommers DR, Joshi R, van Pul C, Feijs L, Oei G, Oetomo SB, Andriessen P. Features of heart rate variability capture regulatory changes during kangaroo care in preterm infants. J Pediatr. 2017;182:92\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTian Y, Inocencio IM, Wong FY. Impact of kangaroo mother care on autonomic cardiovascular control in preterm infants. Pediatr Res. 2025;97:1983\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchulzke SM, Deshpande GC, Patole SK. Neurodevelopmental outcomes of very low birth weight infants. Arch Dis Child. 2007;92:F423\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGregory KE, Deforge CE, Natale KM, Phillips M, Van Marter LJ. Necrotizing enterocolitis in the premature infant. Adv Neonatal Care. 2011;11:155\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Necrotizing enterocolitis, Preterm infants, Non-invasive monitoring, Skin temperature, Physiological monitoring, Neonatal intensive care","lastPublishedDoi":"10.21203/rs.3.rs-9189429/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9189429/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eNecrotizing enterocolitis (NEC) is a critical gastrointestinal disease in preterm infants and a leading cause of morbidity and mortality in neonatal intensive care units. Early identification is essential to prevent severe complications; however, diagnosis remains challenging due to nonspecific early symptoms. This study aimed to evaluate the feasibility of continuous non-invasive multi-site skin temperature monitoring for early assessment of suspected NEC in preterm infants.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA prospective observational pilot study was conducted in a neonatal intensive care unit. Preterm infants (gestational age\u0026thinsp;\u0026lt;\u0026thinsp;37 weeks) clinically suspected of early-stage NEC were enrolled. Continuous skin temperature measurements were obtained at three anatomical sites\u0026mdash;central abdomen, dorsum of the hand, and dorsum of the foot\u0026mdash;using a precision digital thermometer (TM-907A) over a standardized 20-minute monitoring period. Data were recorded and analyzed using a custom LabVIEW-based platform. A total of 16 preterm infants were included in the analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eContinuous multi-site skin temperature monitoring was successfully implemented in all 16 participants without interruption, demonstrating the technical feasibility of real-time physiological data acquisition in a NICU setting. Temperature variations across the three anatomical sites were minimal and did not demonstrate clear differentiation among subjects during the monitoring period. No consistent or distinct temperature patterns were observed, and environmental parameters such as incubator temperature and humidity showed no clear associations with the recorded signals. These findings suggest that temperature-based monitoring alone may have limited sensitivity for early NEC detection, particularly in mild or early-stage cases.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis study confirms the feasibility of continuous non-invasive multi-site physiological monitoring in a neonatal intensive care setting. However, skin temperature monitoring alone did not provide sufficient sensitivity for early NEC detection in this cohort. These preliminary findings highlight the need to integrate additional physiological parameters and multi-modal monitoring approaches to improve diagnostic sensitivity and support the development of data-driven early NEC assessment strategies in preterm infants.\u003c/p\u003e","manuscriptTitle":"Feasibility of Continuous Multi-Site Skin Temperature Monitoring for Early Detection of Necrotizing Enterocolitis in Preterm Infants","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-07 17:32:05","doi":"10.21203/rs.3.rs-9189429/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"92137002505807021357049944335931010799","date":"2026-05-01T03:12:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"236126400439073045079205244852016891940","date":"2026-04-25T06:42:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-24T10:12:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"171153644505191559446448292989637806908","date":"2026-04-24T07:14:42+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-23T06:22:35+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-02T18:25:30+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-02T01:41:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-02T01:40:19+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2026-03-22T06:28:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ccb5d554-6dc2-47c6-948d-17b82ca2a94e","owner":[],"postedDate":"May 7th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"92137002505807021357049944335931010799","date":"2026-05-01T03:12:45+00:00","index":62,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-07T17:32:05+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-07 17:32:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9189429","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9189429","identity":"rs-9189429","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}