Mubashir H Shah
King Edward Memorial (KEM) Hospital, India
Title: Superior mesenteric artery Doppler on first day of life in very low birth weight neonates and prediction of necrotizing enterocolitis; A prospective blinded cohort study
Biography
Biography: Mubashir H Shah
Abstract
Despite a well-known entity, early diagnosis of Necrotizing enterocolitis (NEC) is difficult as no reliable standard imaging techniques are available. Highest risk of NEC is observed in very low birth weight babies. Literature mentions that diagnosis of intestinal ischemia which is the earliest sign before bowel necrosis can reduce the incidence of NEC [2]. We hypothesized that Superior Mesenteric Artery (SMA) Doppler may be a reliable, non-invasive, bedside tool to predict NEC in preterm neonates. We included consecutively born neonates weighing < 1500 grams at birth in this study. SMA Doppler indices (PSV, EDV, TAMV, PI and RI) on first day of life before initiation of enteral feeding were recorded. Attending neonatologist was blinded to Doppler results. Correlation of SMA Doppler indices with NEC was calculated among 2 groups (NEC versus No-NEC group). Comparison of SMA Doppler on day 1 between subgroups of appropriate for gestational age versus small for gestational age neonates was done to demonstrate any correlation with NEC. Further comparison between antenatal umbilical artery Doppler and postnatal day 1 SMA Doppler was done to identify the better predictor of NEC. Out of 114 eligible neonates, 11 (9.6%) developed NEC (≥ Bell’s stage IIA). Although neonates with NEC had lower SMA Doppler velocities; they were not statistically different in 2 groups (NEC vs No-NEC). No correlation was found between PI and RI to predict NEC in this cohort. However, absent or reverse end diastolic flow in umbilical artery continues to be a significant risk factor for NEC (RR=4.15, 95 %CI=1.32-12.97, P=0.01). This study didn’t observe any correlation between SMA Doppler on first day of life and NEC in VLBW neonates. India, being the global capital of preterm births with high incidence of NEC, should focus on high quality research for prevention and early diagnosis of NEC.