Persistent diastolic flow reversal in abdominal aortic Doppler-flow profiles is associated with an increased risk of necrotizing enterocolitis in term infants with congenital heart disease.
OBJECTIVE
Diastolic runoff in the abdominal aorta, with subsequent circulatory mesenteric insufficiency, has been postulated as a cause of necrotizing enterocolitis in term infants with congenital heart disease. With this study we sought to determine whether Doppler-flow characteristics in the abdominal aorta can predict which infants are at specific risk, independent of gestational age and type of congenital heart disease.


METHODS
We conducted a case-control study of term infants with congenital heart disease and proven necrotizing enterocolitis (n = 18) compared with gestational age-matched and diagnosis-matched control subjects (n = 20). Abdominal aortic Doppler velocities, time intervals, and reversals were analyzed. Groups were compared, and independent risk factors for necrotizing enterocolitis were determined.


RESULTS
The groups were similar with regard to weight, pulse pressure, use of prostaglandins or inotropes, presence of a patent ductus arteriosus, and systolic function. However, 47% of the case subjects with necrotizing enterocolitis had persistent retrograde diastolic flow in the abdominal aorta compared with 15% of the control subjects. When adjusting for multiple risk factors, persistent diastolic flow reversal remained the only factor significantly associated with necrotizing enterocolitis.


CONCLUSIONS
Persistent diastolic flow reversal in the abdominal aortic Doppler profile is associated with an increased risk of necrotizing enterocolitis in term infants with congenital heart disease irrespective of gestational age or anatomic type of congenital heart disease.
Carlo
Waldemar F
WF
Division of Cardiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA. waldemar.carlo@cchmc.org
Kimball
Thomas R
TR
Michelfelder
Erik C
EC
Border
William L
WL
D001012:Aorta, Abdominal / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D016022:Case-Control Studies; D003971:Diastole; D020345:Enterocolitis, Necrotizing / Q000209:etiology*; D006330:Heart Defects, Congenital / Q000150:complications* / Q000503:physiopathology*; D006801:Humans; D007231:Infant, Newborn; D012307:Risk Factors; D047929:Term Birth; D018608:Ultrasonography, Doppler