Published online November 1, 2006
PEDIATRICS Vol. 118 No. 5 November 2006, pp. 1999-2003 (doi:10.1542/10.1542/peds.2006-0272)

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ARTICLE

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

Edile M. Murdoch, BM, MRCP^a, Ajay K. Sinha, MD, FRCPCH^b, Shanti T. Shanmugalingam, MB, MRCP, MRCPCH^b, Gordon C.S. Smith, MD, PhD^c and Stephen T. Kempley, MA, FRCPCH^b

^a Neonatal Intensive Care Unit, Addenbrooke's Hospital, Cambridge, United Kingdom
^b Neonatal Intensive Care Unit, Royal London Hospital, Whitechapel, London, United Kingdom
^c Department of Obstetrics and Gynaecology, Cambridge University, Cambridge, United Kingdom

OBJECTIVE. The purpose of this work was to relate Doppler indices of splanchnic perfusion and vascular resistance to the risk of developing necrotizing enterocolitis.

METHODS. We conducted a prospective cohort study with analysis of Doppler flow velocity waveforms of splanchnic vessels on the first day of life. Clinical management and diagnosis of necrotizing enterocolitis were performed blind to the Doppler results in a tertiary NICU on 64 eligible preterm neonates admitted for intensive care. We measured necrotizing enterocolitis using an objective diagnostic classification.

RESULTS. When adjusted for gestational age at birth, the following indices of the Doppler flow velocity wave form in the superior mesenteric artery were significantly predictive of the risk of necrotizing enterocolitis: end-diastolic velocity, mean velocity, and pulsatility index. The association between necrotizing enterocolitis and Doppler velocimetry indicative of high vascular resistance was independent of a range of other factors and comorbidities (race, mode of delivery, umbilical arterial catheter, growth restriction, patent ductus arteriosus, jaundice, respiratory distress syndrome, mechanical ventilation, and hypotension).

CONCLUSIONS. 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.

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Key Words: necrotizing enterocolitis • Doppler ultrasonography • splanchnic circulation • superior mesenteric artery • premature infant

Abbreviations: NEC—necrotizing enterocolitis • SMA—superior mesenteric artery • CA—celiac axis • EDV—end-diastolic velocity • PI—pulsatility index

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Accepted Jun 7, 2006.

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