Early detection of necrotizing enterocolitis in neonates at risk using superior mesenteric artery Doppler parameters with clinical outcome prediction

Abstract Background Necrotizing enterocolitis (NEC) is a dangerous intestinal condition that occurs in neonates. It begins with injury to the intestinal lining and advances to inflammation, tissue necrosis and potentially systemic organ failure. Objectives To evaluate whether Doppler parameters of the superior mesenteric artery (SMA) can help in the early detection of NEC in at-risk neonates and predict clinical outcomes. Methods This prospective cohort study was conducted on thirty-two neonates at neonatal intensive care unit. Those neonates underwent ultrasound due to risk factors of NEC over a 6-month period, from August 2024 to February 2025. Doppler ultrasound measurements were taken on the first admission day with follow-up over 1 month. Results SMA Doppler and bowel ultrasound demonstrated high sensitivity and specificity in early detection of NEC. There was a statistically significant difference between developing NEC and the parameters of high pulsatility index (PI) and low end-diastolic velocity (EDV) at presentation ( P = 0.007, P < 0.001, respectively ) . Additionally, high PI and low peak systolic velocity (PSV) and low EDV at follow-up were predictive of NEC development ( P < 0.001). The percentage of change of PSV and PI was statistically significant higher in patients with NEC than patients without NEC ( P < 0.001, P < 0.002, respectively). Cutoff value was established for PI being more than 2 at presentation and more than 2.4 at follow-up. Moreover, cutoff value for EDV was less than 14 cm/s at presentation and less than 10.4 cm/s at follow-up. These values were the best cutoff points to early detect cases developing NEC. The most important factor at presentation and follow-up to detect NEC was PI. Bowel wall thickening and loss of differentiation were predictive of NEC. Conclusion This study shows an improvement in the ability to early diagnose NEC in neonates with risk factors. Subsequently, it accelerates the management of the disease and reduces morbidity and mortality rates.