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Pediatric Surgery International

, Volume 31, Issue 11, pp 1061–1066 | Cite as

Doppler flowmetry of the superior mesenteric artery and portal vein: impact for the early prediction of necrotizing enterocolitis in neonates

  • Ausra  Urboniene
  • Arvydas  Palepsaitis
  • Rimantas  Uktveris
  • Vidmantas  Barauskas
Original Article

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.

Keywords

Necrotizing enterocolitis Superior mesenteric artery Portal vein Doppler flowmetry 

Notes

Compliance with ethical standards

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.

References

  1. 1.
    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 CrossRefGoogle Scholar
  2. 2.
    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 CrossRefGoogle Scholar
  3. 3.
    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 PubMedGoogle Scholar
  4. 4.
    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 CrossRefPubMedGoogle Scholar
  5. 5.
    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 CrossRefPubMedGoogle Scholar
  6. 6.
    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 CrossRefPubMedGoogle Scholar
  7. 7.
    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 CrossRefPubMedGoogle Scholar
  8. 8.
    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 Google Scholar
  9. 9.
    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 CrossRefPubMedGoogle Scholar
  10. 10.
    Walsh MC, Kliegman RM (1986) Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am 33:179–201PubMedGoogle Scholar
  11. 11.
    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 CrossRefPubMedGoogle Scholar
  12. 12.
    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 PubMedCentralCrossRefPubMedGoogle Scholar
  13. 13.
    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 CrossRefPubMedGoogle Scholar
  14. 14.
    Llanos AR, Moss ME, Pinzòn MC et al (2002) Epidemiology of neonatal necrotising enterocolitis: a population-based study. Paediatr Perinat Epidemiol 16:342–349CrossRefPubMedGoogle Scholar
  15. 15.
    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 CrossRefPubMedGoogle Scholar
  16. 16.
    Stoll BJ (1994) Epidemiology of necrotizing enterocolitis. Clin Perinatol 21:205–218PubMedGoogle Scholar
  17. 17.
    Campbell S, Vyas S, Nicolaides KH (1991) Doppler investigation of the fetal circulation. J Perinat Med 19:21–26CrossRefPubMedGoogle Scholar
  18. 18.
    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 14:2142–2161PubMedCentralCrossRefPubMedGoogle Scholar
  19. 19.
    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 29:379–386PubMedGoogle Scholar
  20. 20.
    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 CrossRefPubMedGoogle Scholar
  21. 21.
    Dimmitt RA, Moss RL (2001) Clinical Management of Necrotizing Enterocolitis. Neoreviews 2:110e–117e. doi: 10.1542/neo.2-5-e110 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Pediatric Surgery DepartmentLithuanian University of Health SciencesKaunasLithuania
  2. 2.Radiology DepartmentLithuanian University of Health SciencesKaunasLithuania

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