Neonatal Med.  2018 May;25(2):78-84. 10.5385/nm.2018.25.2.78.

Descending Aorta Blood Flow Characteristics before the Development of Necrotizing Enterocolitis in Preterm Neonates

• Kim KM
• Kim HS
• Yoon JH
• Lee EJ
• Yum SK
• Moon CJ
• Youn YA
• Kwun YJ
• Lee JY
• Sung IK

• KMID: 2437902
• DOI: http://doi.org/10.5385/nm.2018.25.2.78

Abstract

PURPOSE
To investigate the hemodynamic risk factors for necrotizing enterocolitis (NEC), we analyzed the characteristics of descending aorta (DA) blood flow in preterm neonates, who later developed NEC.
METHODS
This was an observational case-control study on 53 preterm neonates at a tertiary referral center. Clinical and echocardiographic data were collected from 23 preterm neonates with NEC (NEC group), and compared with those of 30 preterm neonates without NEC (control group). Echocardiography was done at a median (interquartile range) of 5 (3-9) days after birth and 2 (1-2.5) days before the diagnosis of NEC.
RESULTS
Basic clinical characteristics including gestational age, birth weight, Apgar score, breast feeding status, use of umbilical catheters, and mode of invasive ventilator care were similar between the groups. Compared with the control group, the lowest diastolic velocity of DA was significantly decreased, whereas the diastolic reverse flow and the ratio of diastolic reverse to systolic forward flows were significantly increased in the NEC group. In addition, the resistive index (RI) of DA was significantly increased in the NEC group and showed a positive association with the development of NEC. Multivariate logistic regression analysis showed that increasing RI of DA was an independent risk factor for the development of NEC (P=0.008).
CONCLUSION
Significant changes in DA flow characteristics including decreased diastolic velocity and increased diastolic reverse flow along with increased peripheral vascular resistance were observed before the development of NEC in preterm neonates. These findings may help clinicians stratify in advance neonates at a risk of developing NEC and may help improve outcomes in these neonates.

Keyword

Doppler flow study; Critical care; Splanchnic circulation; Vascular resistance; Necrotizing enterocolitis; Preterm neonates

MeSH Terms

Aorta, Thoracic*
Apgar Score
Birth Weight
Breast Feeding
Case-Control Studies
Catheters
Critical Care
Diagnosis
Echocardiography
Enterocolitis, Necrotizing*
Gestational Age
Hemodynamics
Humans
Infant, Newborn*
Logistic Models
Parturition
Risk Factors
Splanchnic Circulation
Tertiary Care Centers
Vascular Resistance
Ventilators, Mechanical

Figure

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  Figure 1. A spectral Doppler image of descending aorta flow showing a systolic forward flow and a diastolic reverse flow. Descending aorta blood flow and diastolic reverse flow were calculated using the velocity time integral of the systolic forward flow and diastolic reverse flow, respectively (dotted lines). A resistive index (RI) was calculated from peak systolic velocity and lowest diastolic velocity. RI=(peak systolic velocity–lowest diastolic velocity)/peak systolic velocity.

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