Association between celiac and superior mesenteric arteries' Doppler flow parameters and risk of necrotizing enterocolitis in preterm infants.

Abstract

BackgroundNecrotizing enterocolitis (NEC) remains a significant cause of morbidity and mortality in preterm neonates. Identifying early markers of impaired intestinal perfusion may aid detecting an association with the development of NEC. This study aims to evaluate the role of Doppler ultrasound of the superior mesenteric artery (SMA) and celiac artery (CA) and its association with NEC in preterm neonates.MethodsWe conducted a retrospective, single-center case-control study. Eligible infants were born at <29 weeks' gestation; we excluded those with chromosomal abnormalities, major anomalies, and those without Doppler assessments. NEC cases (Bell stage ≥II) were matched to controls on gestational age and birth weight. We compared SMA and CA Doppler parameters-peak systolic velocity (PSV), end-diastolic velocity (EDV) of NEC and control infants obtained at the end of the first and between 2^nd and 3^rd weeks of life.ResultsAmong 44 preterm infants (NEC = 21; controls = 23), Doppler assessment in the 1^st week showed lower CA PSV in NEC versus controls (AMD = -27.7 cm/s [-53.58, -1.81]; p = 0.0371) after adjustment for PDA, birth weight, and gestational age. In weeks 2-3, and before NEC onset, NEC infants had lower SMA PSV (AMD = -35.7 cm/s [-68.5, -3.00]; p = 0.036) in models adjusted for PDA. No significant differences were found in CA parameters.ConclusionsReduced CA PSV during the first week of life, and reduced SMA PSV prior to NEC onset reflects impaired splanchnic perfusion preceding NEC and may be useful to clinicians in stratifying neonates at a risk of developing NEC in advance.