Doppler sonographic detection of increased flow velocities in the celiac trunk and superior mesenteric artery in infants with necrotizing enterocolitis

Deeg, Karl‐Heinz; Rupprecht, Thomas; Schmid, Edith R.

doi:10.1007/bf02014968

Cited by 56 publications

(59 citation statements)

References 8 publications

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“…However, the lack of an increase in diastolic flow velocities and the increase in the RI constitute a very strong argument for splanchnic vascular constriction [24]. Our results agree with previous research that states that conditions, such as established neonatal necrotizing enterocolitis, are associated with increased superior mesenteric artery (SMA) blood-flow velocity [23,25]. Moreover, in an animal model of NEC, animals with severe NEC showed increases in PSV and RI values, which may suggest that profound bowel ischemia is a trigger for NEC in susceptible animals [24].…”

Section: Discussionsupporting

confidence: 90%

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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Section: Discussionsupporting

confidence: 90%

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

et al. 2017

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“…This clinical study follows on from the work of other investigators who have proposed Doppler US as a non-invasive method for investigating blood flow within the splanchnic arteries and bowel wall, and for monitoring splanchnic vasoconstriction 10 status in newborns with NEC [1,[15][16][17][18]. Choi [15], Deeg [16], and Kempley [17] [9] subsequently demonstrated a correlation between gray-scale and Doppler US findings and outcome in 40 infants with NEC in 2007.…”

Section: Resultsmentioning

confidence: 90%

“…Choi [15], Deeg [16], and Kempley [17] [9] subsequently demonstrated a correlation between gray-scale and Doppler US findings and outcome in 40 infants with NEC in 2007. According to Silva et al [9], the presence of three or more abnormal findings on abdominal US had a sensitivity of 82% and specificity of 78% for a poor outcome defined as needing acute surgical intervention (laparotomy or placement of a peritoneal drain), death or late surgery for intestinal stricture.…”

Section: Resultsmentioning

confidence: 96%

Prospective evaluation of the impact of sonography on the management and surgical intervention of neonates with necrotizing enterocolitis

et al. 2014

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“…The use of abdominal US in NEC has been described in publications since the 1980s and 1990s [6][7][8][9]. It is performed at bedside and provides real-time imaging of the bowel, peritoneal fluid and other abdominal organs, without ionizing radiation.…”

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confidence: 99%

Technical aspects of abdominal ultrasound and color Doppler assessment of bowel viability in necrotizing enterocolitis

Faingold

2018

Pediatr Radiol

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In this issue of Pediatric Radiology, Cuna et al. [1] presented their findings of a systematic review and meta-analysis on the performance of ultrasound (US) for the evaluation of necrotizing enterocolitis (NEC). The authors distinguished US findings that were or were not associated with a need for surgery or with death. The authors appropriately noted that additional study is needed to determine the optimal timing and frequency of US for NEC and to determine whether utilization of US improves outcomes of infants with NEC.In light of this paper and noting an increasing interest in using US to evaluate for NEC, I would like to share my experience with abdominal US in neonates with NEC, particularly in regard to the technical aspects of bowel perfusion and viability assessment.It is well established that NEC is one of the most common acute neonatal gastrointestinal conditions in the neonatal intensive care unit (NICU), affecting the preterm infant in about 90% of the cases. The prevalence is approximately 1-5% of admissions in the NICU [2][3][4]. NEC manifests in the first 2 weeks after birth or later [2]. The diagnosis of NEC might be delayed at times because the early signs are nonspecific [2][3][4][5]. The prognosis of NEC worsens with perforation, and mortality rates range from 15% to 30% [2][3][4].Abdominal radiography is the standard modality for diagnosis, monitoring and guiding management in NEC. The use of abdominal US in NEC has been described in publications since the 1980s and 1990s [6][7][8][9]. It is performed at bedside and provides real-time imaging of the bowel, peritoneal fluid and other abdominal organs, without ionizing radiation.The routine use of US in NEC has been increasing steadily all over the world in the last 12 years. In 2005, the use of color Doppler was described to assess bowel viability in NEC [3]. This article described, for the first time, US and color Doppler US findings (bowel wall, peristalsis, mural perfusion) in the normal neonate and in NEC. The data were compared to abdominal radiography and modified Bell staging and correlated to outcomes. In this study, color Doppler US was more accurate than abdominal radiography in the assessment of transmural necrosis and contributed to the management of neonates with NEC, particularly the ones with moderate or moderate to severe disease (Bell stages 2B and 3A). Other studies also recently demonstrated the applications of US in NEC [10][11][12][13].A comprehensive description of technique and protocol should be made in order to standardize the exams. Attention to technique and standard protocol is crucial to obtain reproducible and reliable examinations. All neonates must be monitored by a bedside nurse throughout the exam. The exam should be stopped in case of desaturation or any signs of instability. Placing the transducer over the abdomen should be done gently because the child might become clinically unstable in case of tenderness and peritonitis. I recommend working closely with the nurses to mobilize and position the babies safe...

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Doppler sonographic detection of increased flow velocities in the celiac trunk and superior mesenteric artery in infants with necrotizing enterocolitis

Cited by 56 publications

References 8 publications

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

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

Prospective evaluation of the impact of sonography on the management and surgical intervention of neonates with necrotizing enterocolitis

Technical aspects of abdominal ultrasound and color Doppler assessment of bowel viability in necrotizing enterocolitis

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