Superior mesenteric artery blood flow velocity in necrotising enterocolitis.

Abstract

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.

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

“…We found no statistically significant difference in celiac artery blood-flow velocity indices between the 2 patient groups. Our findings agreed with an observation, made in the previous studies, that the risk of NEC was not associated with resistance in the celiac artery [15,23]. The origins of the CA and SMA from the Died from septic shock CA PI celiac artery pulsatility index, CA PSV celiac artery peak systolic velocity, CA EDV celiac artery end-diastolic velocity, CA RI celiac artery resistivity index, SMA PI superior mesenteric artery pulsatility index, SMA PSV superior mesenteric artery peak systolic velocity, SMA EDV superior mesenteric artery end-diastolic velocity, SMA RI superior mesenteric artery resistivity index, CA PSV/SMA PSV celiac artery peak systolic velocity/superior mesenteric artery peak systolic velocity descending aorta are almost contiguous, yet they supply very different vascular beds.…”

“…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].…”

“…Our data accord with prospective data that showed low SMA in one infant before the onset of symptoms, suggesting that an ischemic insult to the gut may precede the onset of NEC with increased SMA velocities later, representing post-ischemic hyperemia [23]. Moreover, in a rabbit model, it was found that an insult in a susceptible animal may lead to early profound bowel ischemia, which may trigger NEC.…”

“…Few of our patients had received enteral feeding at any stage in their lives. Enteral feeding has been shown to increase SMA velocity even in premature infants [23], so this may also have contributed to the reduction of the SMA flow velocities in our NEC group. We found no statistically significant difference in celiac artery blood-flow velocity indices between the 2 patient groups.…”

Splanchnic tissue oxygenation, but not brain tissue oxygenation, increases after feeds in stable preterm neonates tolerating full bolus orogastric feeding

“…[1][2][3][4][5] Several reports have shown that enteral feeding induces a significant and progressive increase in blood flow velocity in the superior mesenteric artery that peaks 45-60 min after the meal. [6][7][8][9][10][11][12] The effect of feeding increases with the volume of milk and the interval between feedings. The increase in velocity peaks earlier after breast milk than after formula feeding.…”