Abstract
Purpose
Necrotizing enterocolitis (NEC) is a serious gastrointestinal disorder in newborns. Early diagnosis and rapid treatment is essential for seeking good outcome for neonates. The aim of our study was to evaluate intestinal blood flow in superior mesenteric artery (SMA) and portal vein (PV) in neonates with suspected or confirmed NEC and investigate the prognostic cut-off values to develop NEC.
Methods
Doppler flowmetry of SMA and PV was performed for 62 newborns. Resistive (RI) and pulsatility (PI) indexes were measured in SMA as well as Volumetric blood flow (Vflow) in PV. ROC curves were applied to estimate sensitivity and specificity and to identify cut-off values.
Results
There were 93.5 % preterm neonates. 29 patients (46.8 %) were diagnosed with NEC and 33 (53.2 %) formed a control group. 96.3 % NEC patients had RI >0.75 with sensitivity of 96.3 % and specificity of 90.9 % (OR 260). 88.9 % NEC patients had PI >1.85 with sensitivity of 88.9 % and specificity of 78.8 % (OR 29). Portal Vflow lower than 37 ml/min was present in 89.7 % patients with NEC (OR 11.7).
Conclusion
Intestinal blood flow Dopplerography can be a useful tool for diagnosing and predicting NEC.
Similar content being viewed by others
References
Ahmad Khodair S (2014) Color Doppler blood flow indices of the superior mesenteric artery as an early predictor of necrotizing enterocolitis in preterm neonates. Int J Med Imaging 2:39. doi:10.11648/j.ijmi.20140202.17
Jesse N, Neu J (2006) Necrotizing enterocolitis: relationship to innate immunity, clinical features, and strategies for prevention. Neoreviews 7:e143–e150. doi:10.1542/neo.7-3-e143
Kobayashi M, Mizuno M, Matsumoto A, Wakabayashi G (2015) Neonatal portal venous blood flowmetry by Doppler ultrasound for early diagnosis of ischemia in intestinal tract. Eur J Pediatr Surg 25:292–298. doi:10.1055/s-0034-1374820
Epelman M, Daneman A, Navarro OM et al (2007) Necrotizing enterocolitis: review of state-of-the-art imaging findings with pathologic correlation. Radiographics 27:285–305. doi:10.1148/rg.272055098
Murdoch EM, Sinha AK, Shanmugalingam ST et al (2006) 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 118:1999–2003. doi:10.1542/peds.2006-0272
Robel-Tillig E, Knüpfer M, Pulzer F, Vogtmann C (2004) Blood flow parameters of the superior mesenteric artery as an early predictor of intestinal dysmotility in preterm infants. Pediatr Radiol 34:958–962. doi:10.1007/s00247-004-1285-6
Louis D, Mukhopadhyay K, Sodhi KS et al (2013) Superior mesenteric artery Doppler is poor at predicting feed intolerance and NEC in preterm small for gestational age neonates. J Matern Fetal Neonatal Med 26:1855–1859. doi:10.3109/14767058.2013.799649
Akin MA, Yikilmaz A, Gunes T et al (2014) Quantitative assessment of hepatic blood flow in the diagnosis and management of necrotizing enterocolitis. J Matern Fetal Neonatal Med. doi:10.3109/14767058.2014.980230
Bohnhorst B (2013) Usefulness of abdominal ultrasound in diagnosing necrotising enterocolitis. Arch Dis Child Fetal Neonatal Ed 98:F445–F450. doi:10.1136/archdischild-2012-302848
Walsh MC, Kliegman RM (1986) Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am 33:179–201
Baschat AA, Gembruch U, Reiss I et al (2000) Relationship between arterial and venous Doppler and perinatal outcome in fetal growth restriction. Ultrasound Obstet Gynecol 16:407–413. doi:10.1046/j.1469-0705.2000.00284.x
Johnson JN, Ansong AK, Li JS et al (2011) Celiac artery flow pattern in infants with single right ventricle following the Norwood procedure with a modified Blalock-Taussig or right ventricle to pulmonary artery shunt. Pediatr Cardiol 32:479–486. doi:10.1007/s00246-011-9906-y
Lambert DK, Christensen RD, Henry E et al (2007) Necrotizing enterocolitis in term neonates: data from a multihospital health-care system. J Perinatol 27:437–443. doi:10.1038/sj.jp.7211738
Llanos AR, Moss ME, Pinzòn MC et al (2002) Epidemiology of neonatal necrotising enterocolitis: a population-based study. Paediatr Perinat Epidemiol 16:342–349
Guthrie SO, Gordon PV, Thomas V et al (2003) Necrotizing enterocolitis among neonates in the United States. J Perinatol 23:278–285. doi:10.1038/sj.jp.7210892
Stoll BJ (1994) Epidemiology of necrotizing enterocolitis. Clin Perinatol 21:205–218
Campbell S, Vyas S, Nicolaides KH (1991) Doppler investigation of the fetal circulation. J Perinat Med 19:21–26
Schnabl K-L, Van Aerde J-E, Thomson A-B, Clandinin M-T (2008) Necrotizing enterocolitis: a multifactorial disease with no cure. World J Gastroenterol 14:2142–2161
Choi Y-H, Kim I-O, Cheon J-E et al (2010) Doppler sonographic findings in an experimental rabbit model of necrotizing enterocolitis. J Ultrasound Med 29:379–386
Silva CT, Daneman A, Navarro OM et al (2007) Correlation of sonographic findings and outcome in necrotizing enterocolitis. Pediatr Radiol 37:274–282. doi:10.1007/s00247-006-0393-x
Dimmitt RA, Moss RL (2001) Clinical Management of Necrotizing Enterocolitis. Neoreviews 2:110e–117e. doi:10.1542/neo.2-5-e110
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical approval
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards (Kaunas Regional Committee for Biomedical Research Ethics No. BE 2–17).
Informed consent was obtained from all individual participants’ parents included in the study.
Rights and permissions
About this article
Cite this article
Urboniene, A., Palepsaitis, A., Uktveris, R. et al. Doppler flowmetry of the superior mesenteric artery and portal vein: impact for the early prediction of necrotizing enterocolitis in neonates. Pediatr Surg Int 31, 1061–1066 (2015). https://doi.org/10.1007/s00383-015-3792-y
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-015-3792-y