Early introduction of enteral feeds in growth-restricted preterm infants results in earlier achievement of full enteral feeding and does not appear to increase the risk of NEC.

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Aims-To evaluate whether serial Doppler measurements of superior mesenteric artery (SMA) blood flow velocity after the first enteral feed could predict early tolerance to enteral feeding in preterm infants. Methods-When clinicians decided to start enteral feeds, Doppler ultrasound blood flow velocity in the SMA was determined before and after a test feed of 0.5 ml milk. The number of days taken for infants to tolerate full enteral feeding (150 ml/kg/ day) was recorded. Results-Fourteen infants (group 1) achieved full enteral feeding within seven days. Thirty infants (group 2) took 8-30 days. There was no diVerence in the preprandial time averaged mean velocity (TAMV) between the groups at a median age of 3 (2-30) days. In group 1, there was a significant increase in TAMV (p<0.01) above the preprandial level at 45 and 60 minutes, but this did not occur in group 2. An increase in TAMV by more than 17% at 60 minutes has a sensitivity of 100% and a specificity of 70% for the prediction of early tolerance to enteral feeds. Conclusions-There is a significant correlation between an increase in mean SMA blood flow velocity and early tolerance of enteral feeding. Doppler measurements of SMA blood flow velocity may be useful for deciding when to feed high risk preterm infants. (Arch Dis Child Fetal Neonatal Ed 2001;85:F42-F45)

We concluded that neonates with high resistance patterns of blood flow velocity in the superior mesenteric artery on the first day of life are at increased risk of developing necrotizing enterocolitis.

Blood flow velocity and pulsatility index were measured with Doppler ultrasound in the superior mesenteric artery, coeliac axis, and anterior cerebral artery in 18 very low birth weight, small for gestational age infants, and compared with findings from 18 weight matched, and 18 gestation matched, appropriate for gestational age controls. Mean velocity in the superior mesenteric artery was lower in the small for gestational age infants (15 cm/s) than in the gestation matched control group (20-4 cm/s). In those small for gestational age infants who had evidence of fetal hypoxia the mean velocity in the superior mesenteric artery was even lower (115 cm/s). There were no differences in velocity in the cerebral artery among the groups. Infants who were small for gestational age still had significantly lower superior mesenteric artery velocity than gestation matched controls at 1 week of age.The results suggest a specific reduction in visceral perfusion in infants who are small for gestational age and who have experienced fetal hypoxia, and this could predispose these infants to necrotising enterocolitis.

Doppler measurements of blood flow velocity were obtained from the superior mesenteric artery (SMA), coeliac axis, and anterior cerebral artery (ACA) of 19 infants with suspected necrotising enterocolitis, which was classified as confirmed (n=9) or unconfirmed (n=8). Infants with confirmed disease were compared with controls who were either enterally fed or who were receiving intravenous fluids.SMA velocity was significantly higher in the infants with confirmed necrotising enterocolitis (36.5 cm/s) than in unfed controls (20.4 cm/s) or infants with unconfirmed enterocolitis (19.6 cm/s).Three infants with confirmed disease had data from before the onset of symptoms. One had low SMA velocity on the first day of life, and one showed no increase in SMA velocity after enteral feeds were started.SMA velocity is increased when infants develop symptoms of necrotising enterocolitis, suggesting that total gut ischaemia is not present at the time that the disease is clinically apparent, although it may precede the onset of symptoms and play a part in the pathogenesis of the disorder.

Objective: A single value of plasma creatinine cannot be used to define renal dysfunction in premature babies, as levels are influenced by gestation and postnatal age. The aim of this study was to create reference ranges for plasma creatinine in cohort of extremely premature infants.Study Design: Retrospective analysis of plasma creatinine levels in the first 8 weeks of life from 161 consecutively admitted premature infants 28 weeks gestation.Result: Babies were divided into three groups according to gestation. Peak (10th, 90th percentiles) creatinine levels were 132 (106,162) in 22 to 24 weeks gestational infants, 127 (89,151) in those from 25 to 26 weeks and 110 (87,134) in those from 27 to 28 weeks (P<0.001). Creatinine at birth was similar across the groups with levels increasing during the first few days. It decreases thereafter before reaching stable levels by 5 weeks of age.Conclusion: Gestation-and age-based reference charts should be used for interpretation of creatinine values in extremely premature babies.

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