Doppler Flow Velocimetry in the Superior Mesenteric Artery on the First Day of Life in Preterm Infants and the Risk of Neonatal Necrotizing Enterocolitis

Murdoch, Edile; Sinha, Ajay; Shanmugalingam, Shanti T; Smith, Gordon C. S.; Kempley, Stephen

doi:10.1542/peds.2006-0272

Cited by 96 publications

(67 citation statements)

References 13 publications

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“…The changes observed on the first day of life most likely represent persistence of these fetal redistribution patterns into postnatal life, as stated in the study by Campbell et al [16] In this study, the patterns of Doppler flow indices indicating increased resistance in the SMA were associated with an increased risk of NEC. This finding was in accordance with those of Murdoch et al [14], who suggested that splanchnic flow was compromised immediately after birth in many infants who went on to develop NEC.…”

Section: Discussionsupporting

confidence: 93%

“…Previous studies have shown that high resistance to flow in the SMA was associated with a delay in establishing feeding and those infants with risk factors for NEC tended to have higher resistance patterns of flow in the SMA. [8,14] In this study, twelve neonates (23%) developed NEC, which is a relatively high incidence of NEC and could be explained by most studied neonates who developed NEC having extremely low birth weights (<1000 g); this finding was in accordance with those of Kliegman et al [15], who stated that among infants with very low birth weights (VLBW, <1500 g), the incidence might be as high as 15%, with a mortality rate of 10-30%.…”

Section: Discussionmentioning

confidence: 99%

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Color Doppler Blood Flow Indices of the Superior Mesenteric Artery as an Early Predictor of Necrotizing Enterocolitis in Preterm Neonates

Khodair¹,

Ghieda²,

Abdelnaby³

2014

IJMI

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Abstract:Background: Necrotizing enterocolitis is the most common sever gastrointestinal emergency that affects premature newborns. It is often has a rapid onset with few signs that can be used to predict its occurrence. Its rapid onset and progression to morbidity and mortality initiates the researchers for seeking early diagnostic tools helping in detection infants at risk for development of the disease, for whom early preventive measures could be targeted. Previous studies have shown that high resistance patterns of mesenteric arterial Doppler flow velocimetry are associated with a significantly reduced tolerance to enteral feeding. Moreover, groups of infants deemed to be at increased risk of necrotizing enterocolitis tended to have high resistance patterns of flow in the superior mesenteric artery. AIM: To evaluate the Doppler blood flow indices of the superior mesenteric artery (SMA) in pre-term neonates at risk for developing necrotizing enterocolitis (NEC). Materials and Methods: This prospective study included 52 preterm neonates, whose gestational age was less than 34 weeks. All of the neonates were subjected to clinical assessments, laboratory investigations and color Doppler flow evaluation of the SMA (including PSV, EDV, RI and PI) on the first day of life. Necrotizing enterocolitis was diagnosed and classified based on Bell's staging criteria with Walsh and Kliegman's modifications. Clinical management and diagnosis of NEC were performed blind to the Doppler results. Statistical analysis was performed using the Mann-Whitney U test, and P-values less than or equal to 0.05 were statistically significant. Receiver operating characteristic (ROC) curves were used to determine the optimal threshold values of PSV, EDV, RI and PI, using MedCalc software, version 12.7.8.0. Results: The study included 52 preterm neonates, whose gestational age was less than 34 weeks. Twelve neonates (23%) developed NEC and were designated as group I, and the remaining 40 neonates (77%) were designated as group II. The median birth weights in groups I and II were 1000 and 1870 g, respectively, with a statistically significant difference of P < 0.05. Doppler indices of the SMA, peak systolic velocity (88.9 ±17 and 53 ±8.5 cm/s), end diastolic velocity (18.75±11.3 and 14.9±5.6 cm/s), resistive index (0.78±0.09 and 0.67±0.1) and pulsatility index (1.53±0.73 and 0.67 ± 0.15) were higher in group I than in group II, with statistically significant differences. Conclusion: Preterm infants with high resistance patterns of blood flow velocity in the SMA on the first day of life were at increased risk for developing necrotizing enterocolitis.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Color Doppler Blood Flow Indices of the Superior Mesenteric Artery as an Early Predictor of Necrotizing Enterocolitis in Preterm Neonates

Khodair¹,

Ghieda²,

Abdelnaby³

2014

IJMI

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“…CAF:LVO was lower in infants with adverse outcomes. Although this did not reach statistical significance possibly due to small numbers, it may explain the association between PDA and necrotizing enterocolitis, IVH and death [16,17] . LA:Ao was significantly higher in infants with IVH, and DAo EDV was lower in infants that died, and those requiring ventilation on day 3.…”

Section: Discussionmentioning

confidence: 74%

Quantitative Assessment of the Degree of Ductal Steal Using Celiac Artery Blood Flow to Left Ventricular Output Ratio in Preterm Infants

et al. 2007

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Background: Determining the significance of a patent ductus arteriosus (PDA) remains difficult in preterm neonates and current echocardiographic markers give little information about ductal steal. We hypothesized that the relationship between celiac artery flow (CAF) and left ventricular output (LVO) in the presence of a PDA may determine haemodynamic significance. Objectives: To examine CAF to LVO ratio (CAF:LVO) in the presence and the absence of a PDA in preterm neonates, and to compare CAF:LVO to current echocardiographic markers of a significant PDA. Methods: This was a prospective observational study of neonates <1,500 g. Echocardiography was performed at 12 h and day 3. PDA, LVO and CAF were measured by echocardiography. The infants were divided into those who developed a significant PDA (PDA >1.4 mm and left atrial to aortic ratio >1.5 on day 3) and controls. A further assessment was carried out following successful PDA treatment with ibuprofen or surgical ligation. Results: A total of 33 infants were enrolled. 19 infants had a PDA (median gestation 27 weeks, birth weight 915 g), and 14 controls (gestation 28.7 weeks, birth weight 1,110 g). At 12 h, there was no difference in CAF, LVO or CAF:LVO. On day 3, there was a significant difference in CAF:LVO between PDA versus control groups. CAF:LVO significantly correlated with conventional markers of ductal significance. A CAF:LVO value of 0.10 had a sensitivity of 93% and a specificity of 78% for the presence of a significant PDA. Following successful PDA treatment CAF:LVO returned to levels similar to controls. Conclusion: CAF:LVO may be used to determine which PDA warrants treatment and serve as a marker of treatment success. Trials are needed to correlate CAF:LVO with outcome and the impact of basing PDA treatment on this ratio.

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“…The significant reduction in the SMA EDV in the NEC cases in our study matched that in Murdoch et al's study, which found that the risk of NEC significantly decreased with the rise in the end-diastolic flow velocity and that infants who developed NEC later in the neonatal period had a high resistance pattern in the SMA, or the celiac artery, on their first day of life. That may be attributed to the fact that the vasoconstriction of the circulation in neonatal life has a role in the etiology of NEC [22]. Few of our patients had received enteral feeding at any stage in their lives.…”

Section: Discussionmentioning

confidence: 93%

Doppler ultrasound assessment of the splanchnic circulation in preterms with neonatal sepsis at risk for necrotizing enterocolitis

et al. 2017

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Objective To evaluate the role of Doppler ultrasonography in the assessment of splanchnic circulation's hemodynamic changes in septic preterms at risk of necrotizing enterocolitis. Methods A total of 51 septic preterms were divided into two groups: 25 preterms with clinical signs of necrotizing enterocolitis (NEC) and 26 preterms with no clinical signs of NEC. Both groups were assessed with Doppler ultrasonography of the celiac and superior mesenteric arteries, and each septic preterm's peak systolic velocity (PSV), end-diastolic velocity (EDV), resistivity index (RI), and pulsatility index (PI) was calculated and recorded. Results These included a statistically significant lower PSV (p: 0.001) and a lower EDV (p: 0.001) in the superior mesenteric artery in the septic group with clinical signs of NEC in comparison with the septic group with no clinical signs of NEC. A statistically significant (p \ 0.001) higher PSV celiac (CA)/PSV superior mesenteric (SMA) ratio was found for the group of septic preterms with clinical signs of NEC when compared to the other group. Conclusion The study results showed that Doppler ultrasonography of the splanchnic circulation can be a tool for the early identification of NEC cases among septic preterms.Keywords Doppler ultrasonography Á Splanchnic circulation Á Sepsis Á Preterms Á NEC Sommario Obiettivo valutare il ruolo del Doppler nella valutazione dei cambiamenti emodinamici del circolo splancnico in pz pretermine settiche e a rischio di enterocolite necrotizzante. Metodi 51 pazienti pretermine settiche divise in due gruppi sia con segni clinici di enterocolite necrotizzante (NEC) o asintomatiche, entrambi valutati con Doppler a ultrasuoni delle arterie celiaca e mesenterica superiore, con velocità di picco sistolico (PSV), fine della velocità diastolica (EDV), indice di resistività (RI), indice di pulsatilità (PI) il calcolo e la registrazione. Risultati il più basso PSV è risultato statisticamente significativo (p: 0.001), il valore inferiore di EDV (p: 0.001) campionati a livello dell'arteria mesenterica superiore nel gruppo settico con segni clinici di NEC, a confronto con il gruppo delle settiche senza segni clinici di NEC. Statisticamente significativa (p \ 0.001) l'aumento del rapporto PSV celiaco (CA)/PSV a livello della mesenterica superiore (SMA) nel gruppo di sepsi con segni clinici di NEC in confronto con l'altro gruppo. Conclusione I risultati dello studio hanno mostrato che il Doppler del circolo splancnico può essere uno strumento di identificazione precoce dei casi NEC tra le pazienti pretermine settiche.

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Doppler Flow Velocimetry in the Superior Mesenteric Artery on the First Day of Life in Preterm Infants and the Risk of Neonatal Necrotizing Enterocolitis

Abstract: 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.

Cited by 96 publications

References 13 publications

Color Doppler Blood Flow Indices of the Superior Mesenteric Artery as an Early Predictor of Necrotizing Enterocolitis in Preterm Neonates

Color Doppler Blood Flow Indices of the Superior Mesenteric Artery as an Early Predictor of Necrotizing Enterocolitis in Preterm Neonates

Quantitative Assessment of the Degree of Ductal Steal Using Celiac Artery Blood Flow to Left Ventricular Output Ratio in Preterm Infants

Doppler ultrasound assessment of the splanchnic circulation in preterms with neonatal sepsis at risk for necrotizing enterocolitis

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