The intensity of mesenterial blood flow and the degree of intestinal maturity in newborns at risk of necrotizing enterocolitis

Background. In recent years, the use of abdominal ultrasound for the diagnosis of necrotizing enterocolitis (NEC) in newborns has spread. At the initial stages of the disease, intestinal wall thickness, echogenicity and perfusion increase due to intestinal inflammation and mucosal edema. With the progression of NEC, thinning of the intestinal wall, lack of perfusion and peristalsis prevail and warn of the risk of intestinal perforation. This is the evidence of the diagnostic advantage of ultrasound in assessing the progression of NEC. The article presents some results of our own experience of using abdominal ultrasound to diagnose NEC in premature babies. The purpose was to assess the degree of intestinal maturity and the relationship between Doppler indices of intestinal perfusion and vascular resistance in the superior mesenteric arterial bed in premature newborns on day 1–5 of life who are at risk of developing NEC. Materials and methods. The authors examined 34 randomly selected premature babies with low and very low body weight and gestational age from 28 to 36 weeks who were born to mothers with complications of pregnancy. Maximum systolic velocity, end-diastolic velocity, and mean blood flow velocity were assessed at ≥ 5 consecutive heartbeats. Based on these indicators, the pulse index was calculated. Results. After the study on days 1–5 of life the newborns were divided retrospectively into groups depending on clinical diagnoses at the end of the early neonatal period. Babies born with severe asphyxia, with high vascular resistance in the superior mesenteric artery on day 1–5 of life, as well as with a bowel wall thickness of less than 1.6 mm, have an increased risk of developing NEC. Conclusions. The revealed high vascular resistance in the superior mesenteric artery on day 1–5 of life in premature infants with very low body weight and with a high risk of developing NEC will help make correct clinical decisions on ma­nagement and treatment, including the initiation of enteral nutrition and expanding its volume.