Volume 2, Issue 2, March 2014, Page: 39-43
Color Doppler Blood Flow Indices of the Superior Mesenteric Artery as an Early Predictor of Necrotizing Enterocolitis in Preterm Neonates
Sameh Ahmad Khodair, Radiology Department, Tanta University, Tanta, Egypt
Usama Elsaied Ghieda, Radiology Department, Tanta University, Tanta, Egypt
Sameh Abdallah Abdelnaby, Pediatric Department, Menoufia University, Sheben Elkom, Egypt
Received: Mar. 26, 2014;       Accepted: Apr. 9, 2014;       Published: Apr. 10, 2014
DOI: 10.11648/j.ijmi.20140202.17      View  2895      Downloads  184
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 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
Color Doppler Ultrasonography, Superior Mesenteric Artery, Necrotizing Enterocolitis, Preterm Birth, Neonates
To cite this article
Sameh Ahmad Khodair, Usama Elsaied Ghieda, Sameh Abdallah Abdelnaby, Color Doppler Blood Flow Indices of the Superior Mesenteric Artery as an Early Predictor of Necrotizing Enterocolitis in Preterm Neonates, International Journal of Medical Imaging. Vol. 2, No. 2, 2014, pp. 39-43. doi: 10.11648/j.ijmi.20140202.17
Claud, E.C.: Neonatal Necrotizing Enterocolitis -Inflammation and Intestinal Immaturity. Antiinflamm Antiallergy Agents Med Chem, 2009. 8(3): p. 248-259.
Hunter CJ, Podd B, Ford HR, Camerini V. Evidence vs experience in neonatal practices in necrotizing enterocolitis. J Perinatol, 2008. 28 Suppl 1: p. S9-S13.
Pellegrini M, Lagrasta N, Garcìa Garcìa C, Campos Serna J, Zicari E, Marzocca G. Neonatal necrotizing enterocolitis: a focus on. Eur Rev Med Pharmacol Sci, 2002. 6(1): p. 19-25.
Gugliantini P., M. Ricci, and G. Maragliano, [Imaging in the diagnosis of neonatal necrotizing enterocolitis and its complications]. Radiol Med, 1999. 98(6): p. 441-6
Epelman M, Daneman A, Navarro OM, Morag I, Moore AM, Kim JH, Faingold R, Taylor G, Gerstle JT. Necrotizing enterocolitis: review of state-of-the-art imaging findings with pathologic correlation. RadioGraphics, 2007. 27(2): p. 285-305.
Kim WY, Kim WS, Kim IO, Kwon TH, Chang W, Lee EK. Sonographic evaluation of neonates with early-stage necrotizing enterocolitis. Pediatr Radiol, 2005. 35(11): p. 1056-61.
Faingold R, Daneman A, Tomlinson G, Babyn PS, Manson DE, Mohanta A, Moore AM, Hellmann J, Smith C, Gerstle T, Kim JH .Necrotizing enterocolitis: assessment of bowel viability with color doppler US. Radiology, 2005. 235(2): p. 587-94
Robel-Tillig E, Knüpfer M, Pulzer F, Vogtmann C., Blood flow parameters of the superior mesenteric artery as an early predictor of intestinal dysmotility in preterm infants. Pediatr Radiol, 2004. Dec;34(12): p. 958-62
Walsh MC, and Kliegman RM, Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am, 1986. 33(1): p. 179-201
Lambert DK, Christensen RD, Henry E, Besner GE, Baer VL, Wiedmeier SE, Stoddard RA, Miner CA, Burnett J Necrotizing enterocolitis in term neonates: data from a multihospital health-care system. J Perinatol, 2007. 27(7): p. 437-43
Kosloske AM. Epidemiology of necrotizing enterocolitis. Acta Paediatr Suppl, 1994. 396: p. 2-7
Tudehope D.I. The epidemiology and pathogenesis of neonatal necrotizing enterocolitis. J Paediatr Child Health, 2005. 41(4): p. 167-8
Noerr B. Current controversies in the understanding of necrotizing enterocolitis. Part 1. Adv Neonatal Care, 2003. 3(3): p. 107-20
Murdoch EM, Sinha AK, Shanmugalingam ST, Smith GC, Kempley ST., Doppler flow velocimetry in the superior mesenteric artery on the first day of life in preterm infants and the risk of neonatal necrotizing enterocolitis. Pediatrics, 2006. 118(5): p. 1999-2003
Kliegman R.M. Neonatal necrotizing enterocolitis: bridging the basic science with the clinical disease. J Pediatr, 1990. 117(5): p. 833-5
Campbell S, Vyas S, Nicolaides KH. Doppler investigation of the fetal circulation. J Perinat Med, 1991. 19(1-2): p. 21-6
Browse journals by subject