Prediction of early tolerance to enteral feeding by measurement of superior mesenteric artery blood flow velocity: appropriate- versus small-for-gestational-age preterm infants.
OBJECTIVE
To evaluate whether serial Doppler measurements of superior mesenteric artery blood flow velocity could predict early tolerance to enteral feeding in preterm infants.


METHODS
In a prospective study, 54 healthy preterm neonates were assigned to one of the following groups: neonates with birthweight appropriate for gestational age (group 1), neonates small for gestational age without (group 2) and with prenatal haemodynamic disturbances (group 3). We studied Doppler blood flow velocity and resistance index before and after the first feed.


RESULTS
Contrary to patients of group 3, infants in groups 1 and 2 showed a significant increase in blood flow velocity and a significant decrease in resistance index from the preprandial values after the first feed. At each postprandial time, we found significant differences in all velocity and resistance measurements between patients of group 3 and patients of both groups 1 and 2. In all patients, we found that the value of mean velocity measured 30 min after the first feed was the most predictive of early feed tolerance, with 95% sensitivity and 94% specificity when mean velocity >0.38 m/s.


CONCLUSIONS
Small-for-gestational-age preterm infants with prenatal haemodynamic disturbances have an unusual intestinal haemodynamic response to the first feed. In the whole group of preterm infants, the value of mean velocity measured 30 min after the first feed is a good tool for the clinician in predicting early enteral feeding.
Pezzati
M
M
Department of Critical Care Medicine, Section of Neonatology, University of Firenze, Careggi University Hospital, Firenze, Italy. pezzatim@ao-careggi.toscana.it
Dani
C
C
Tronchin
M
M
Filippi
L
L
Rossi
S
S
Rubaltelli
F F
FF
D001783:Blood Flow Velocity; D004750:Enteral Nutrition; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging*; D019518:Postprandial Period; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018608:Ultrasonography, Doppler