Prediction of feed intolerance and necrotizing enterocolitis in neonates with absent end diastolic flow in umbilical artery and the correlation of feed intolerance with postnatal superior mesenteric artery flow.
OBJECTIVE
To evaluate the role of postnatal superior mesenteric artery (SMA) flow in predicting feed intolerance and NEC in the babies who had AEDF in comparison with gestation matched SGA and AGA with normal flow.


METHODS
This was a prospective cohort study conducted in 62 eligible babies admitted in NICU. Babies were enrolled in 3 groups. Group 1 (n = 23) was SGA and AEDF, group 2 (n = 20) was SGA and group 3 (n = 19) was AGA and both with normal UA flow. In all babies baseline SMA flow was measured before test feed (0.5 ml) and repeated every 15 minutes for 1 hour after the feed.


RESULTS
Feed intolerance was seen in 69.5% of babies in group1 (p = <0.001) as compared to 20% and 17.5% in group 2 and 3. Four (17.3%) babies developed NEC in group1 (p = 0.02) but none in other 2 groups. Baseline peak systolic velocity (PSV) and time average mean velocity (TAMV) at 60 min post feed were significantly (p = 0.01 and 0.028 respectively) lower in group1 than group3. TAMV and PSV at 60 min post feed were significantly lower (p = 0.028 and 0.03) in babies with feed intolerance as compared to no feed intolerance group. Absent end diastolic flow and hypoglycemia were independent risk factors for feed intolerance.


CONCLUSIONS
SGA babies with AEDF had higher incidence of feed intolerance and NEC. Serial SMA flow studies specially the 60 min post feed study may help in differentiating which babies are likely to develop feed intolerance.
Bora
R
R
Division of Neonatology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
Mukhopadhyay
K
K
Saxena
A K
AK
Jain
V
V
Narang
A
A
D001783:Blood Flow Velocity / Q000502:physiology; D016022:Case-Control Studies; D003971:Diastole / Q000502:physiology; D020345:Enterocolitis, Necrotizing / Q000503:physiopathology*; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D053120:Respiratory Aspiration / Q000503:physiopathology*; D012307:Risk Factors; D018608:Ultrasonography, Doppler; D014469:Umbilical Arteries / Q000000981:diagnostic imaging*