title: Predictors of necrotizing enterocolitis in preterm growth-restricted neonates.
abstract: OBJECTIVE
  The purpose of this study was to test the hypothesis that multivessel fetal Doppler imaging provides enhanced prediction of necrotizing enterocolitis (NEC) in preterm placental insufficiency.
  
  
  METHODS
  Placental-based growth-restricted fetuses (abdominal circumference <5%, abnormal umbilical artery [UA] Doppler imaging) were examined. UA, middle cerebral artery, ductus venosus, and umbilical vein (UV) were evaluated prenatally and were assessed for their ability to predict NEC in neonates who were delivered at <37 weeks of gestation.
  
  
  RESULTS
  Thirty-nine of 404 neonates (9.7%) experienced NEC. Among these, the mortality rate was 15.4% (6/39 neonates; odds ratio, 2.7; 95% CI, 1.03-7.11). NEC cases had higher UA Doppler indices prenatally (P = .023), lower gestational ages and birthweight at delivery (P < .0001, respectively), 5-minute Apgar scores of <7, and higher umbilical cord artery base deficit (P < .01, respectively). NEC was more likely after prenatal UV pulsations (odds ratio, 2.4; 95% CI, 1.13-5.14; P = .028) and severe cardiovascular abnormality (composite variable incorporating UA- absent or reversed end diastolic velocity, absent or reversed ductus venosus a-wave, or UV pulsations; odds ratio, 2.1; 95% CI, 1.06-4.05; P = .029) Logistic regression revealed birthweight and base deficit as the main contributors of NEC (r(2) = 0.20; P < .0001). Receiver operating characteristic analyses revealed birthweight of <790 g (sensitivity, 74.4%; specificity, 72.9%; P < .0001) and gestational age of < or =32.2 weeks (sensitivity, 94.9%; specificity, 45.8%; P < .0001) as optimal cut-offs that provide an odds ratio for NEC of 8.2 (95% CI, 3.9-17.6; P < .0001).
  
  
  CONCLUSIONS
  Placental disease predisposes the severely growth-restricted neonate to necrotizing enterocolitis. Even when arterial and venous Doppler variables are taken into consideration, birthweight remains the predominant risk factor for NEC. Further research should focus on the critical transition to neonatal life to identify relevant triggers in predisposed neonates.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Anita C
authors.initials: AC
authors.lastname: Manogura
authors.forename: Ozhan
authors.initials: O
authors.lastname: Turan
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Kush
authors.forename: Christoph
authors.initials: C
authors.lastname: Berg
authors.forename: Amarnath
authors.initials: A
authors.lastname: Bhide
authors.forename: Sifa
authors.initials: S
authors.lastname: Turan
authors.forename: Dolores
authors.initials: D
authors.lastname: Moyano
authors.forename: Sarah
authors.initials: S
authors.lastname: Bower
authors.forename: Kypros H
authors.initials: KH
authors.lastname: Nicolaides
authors.forename: Henry L
authors.initials: HL
authors.lastname: Galan
authors.forename: Thomas
authors.initials: T
authors.lastname: Müller
authors.forename: Baskaran
authors.initials: B
authors.lastname: Thilaganathan
authors.forename: Ulrich
authors.initials: U
authors.lastname: Gembruch
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Harman
authors.forename: Ahmet A
authors.initials: AA
authors.lastname: Baschat
mesh_terms: D020345:Enterocolitis, Necrotizing / Q000000981:diagnostic imaging*; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging*; D005544:Forecasting; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010922:Placenta Diseases / Q000000981:diagnostic imaging*; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth; D012307:Risk Factors; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal