Feeding preterm neonates with patent ductus arteriosus (PDA): intestinal blood flow characteristics and clinical outcomes

Abstract Objective: To evaluate the effects of patent ductus arteriosus (PDA) on postprandial superior mesenteric artery blood flow velocities (SMA BFV)s and feeding tolerance in extremely low birth weight (ELBW) neonates. Methods: Appropriate for gestational age, ELBW preterm neonates, tolerating bolus enteral feedings were eligible to participate in this prospective observational study. Pulsed Doppler was used to measure preprandial and postprandial (at 30 and 60 min) time-averaged mean velocity (TAMV), peak systolic velocity (PSV) and end diastolic velocity (EDV) once during the day of life 5–7; at the same time, PDA size was estimated using the PDA: left pulmonary artery (LPA) ratio. Results: A total of 38 infants were studied, 16 in small, 13 in moderate and 9 in large PDA groups. The postprandial SMA BFVs were lower in the large PDA group, although not reaching statistical significance. Importantly, infants in the large PDA group reached full enteral intake later (p = 0.02) and had higher incidence of death secondary of necrotizing enterocolitis (NEC; p = 0.04). Conclusions: ELBW preterm neonates with large PDA may have attenuated intestinal blood flow responses to feedings. There was also an association with higher rates of necrotizing enterocolitis and feeding intolerance in the large PDA group.

[1]  C. Ramaciotti,et al.  Early echocardiographic prediction of ductal closure in neonates ⩽30 weeks gestation , 2013, Journal of Perinatology.

[2]  J. Mirpuri,et al.  Prolonged persistent patent ductus arteriosus: potential perdurable anomalies in premature infants , 2012, Journal of Perinatology.

[3]  C. Ramaciotti,et al.  Echocardiographic predictors of symptomatic patent ductus arteriosus in extremely-low-birth-weight preterm neonates , 2010, Journal of Perinatology.

[4]  A. Oestreich.  Neonatal colour Doppler ultrasound study: normal values of abdominal blood flow velocities in the neonate during the first month of life , 2010 .

[5]  P. McNamara,et al.  Does echocardiography facilitate determination of hemodynamic significance attributable to the ductus arteriosus? , 2009, European Journal of Pediatrics.

[6]  D. Mccurnin,et al.  Effects of a Patent Ductus Arteriosus on Postprandial Mesenteric Perfusion in Premature Baboons , 2008, Pediatrics.

[7]  J. Carver,et al.  Umbilical artery catheters do not affect intestinal blood flow responses to minimal enteral feedings , 2007, Journal of Perinatology.

[8]  Gordon C. S. Smith,et al.  Doppler Flow Velocimetry in the Superior Mesenteric Artery on the First Day of Life in Preterm Infants and the Risk of Neonatal Necrotizing Enterocolitis , 2006, Pediatrics.

[9]  D. Doherty,et al.  Does patent ductus arteriosus affect feed tolerance in preterm neonates? , 2006, Archives of Disease in Childhood - Fetal and Neonatal Edition.

[10]  Evelyn R. Hermes-DeSantis,et al.  Patent ductus arteriosus: pathophysiology and management , 2006, Journal of Perinatology.

[11]  William Stewart,et al.  Recommendations for chamber quantification. , 2006, European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology.

[12]  Richard B Devereux,et al.  Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardio , 2005, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[13]  L. Hornberger,et al.  Relation of limiting ductal patency to survival in neonatal Ebstein's anomaly. , 2005, The American journal of cardiology.

[14]  J. Huhta,et al.  The Hemodynamic Effects of Neonatal Patent Ductus Arteriosus Shunting on Superior Mesenteric Artery Blood Flow , 2005, Journal of Perinatology.

[15]  A. Lusky,et al.  Patent Ductus Arteriosus, Indomethacin and Necrotizing Enterocolitis in Very Low Birth Weight Infants: A Population-Based Study , 2005, Journal of pediatric gastroenterology and nutrition.

[16]  S. Patole,et al.  Does carboxymethylcellulose have a role in reducing time to full enteral feeds in preterm neonates? , 2004, International journal of clinical practice.

[17]  T. Rand,et al.  Effects of umbilical arterial catheterization on mesenteric hemodynamics , 1996, Pediatric Radiology.

[18]  F. Pulzer,et al.  Blood flow parameters of the superior mesenteric artery as an early predictor of intestinal dysmotility in preterm infants , 2004, Pediatric Radiology.

[19]  S. Kempley,et al.  Prediction of early tolerance to enteral feeding in preterm infants by measurement of superior mesenteric artery blood flow velocity , 2001, Archives of disease in childhood. Fetal and neonatal edition.

[20]  K. Maruyama,et al.  Intestinal blood-flow velocity in uncomplicated preterm infants during the early neonatal period , 1999, Pediatric Radiology.

[21]  L. Hanssler,et al.  Effect of umbilical arterial catheters on intestinal blood supply , 1998, Acta paediatrica.

[22]  B. Fish,et al.  Umbilical artery catheters and blood flow velocities in the superior mesenteric artery: Effect of insertion, removal, aspiration, and bolus infusion , 1998, Journal of clinical ultrasound : JCU.

[23]  M. Martinussen,et al.  Validity of Doppler measurements of superior mesenteric artery blood flow velocity: Comparison with blood flow measured by microsphere technique , 1996 .

[24]  D. Burge.  Superior mesenteric artery blood flow velocity in necrotising enterocolitis , 1993 .

[25]  T. Tracy.  Abnormal gut blood flow velocities in neonates at risk of necrotising enterocolitis , 1993 .

[26]  S. Kempley,et al.  Randomised trial of umbilical arterial catheter position: Doppler ultrasound findings. , 1992, Archives of disease in childhood.

[27]  D. Burge.  Gut blood flow velocities in the newborn: Effects of patent ductus arteriosus and parenteral indomethacin , 1991 .

[28]  R. Lo,et al.  Abnormal renal and splanchnic arterial Doppler pattern in premature babies with symptomatic patent ductus arteriosus. , 1990, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.