Early Prediction of Necrotizing Enterocolitis in Risky Neonates by Superior Mesenteric Artery Doppler and Fecal Calprotectin

Introduction: Necrotizing enterocolitis (NEC), a life-threatening gastrointestinal disorder in preterm neonates, lacks reliable early diagnostic markers. Fecal calprotectin helps in early NEC detection by indicating intestinal inflammation. SMA Doppler studies show higher Peak Systolic Velocity (PSV), Resistive Index (RI), Pulsatility Index (PI), and lower End-Diastolic Velocity (EDV) in NEC, reflecting its role in disease risk and severity. Aim of the study This study aims to evaluate the role of Superior Mesenteric Artery (SMA) Doppler ultrasonography and fecal calprotectin levels in the early prediction of NEC in high-risk neonates. Subjects and Methods: This a cross-sectional study that was conducted on 75 preterm (28-36 weeks) neonates from Al-Azhar University NICU, categorized into 25 suspected NEC (stage I), 25 confirmed NEC (stages II/III), and 25 controls, during the period from February 2023 to February 2025. Results: Fecal calprotectin was markedly elevated in confirmed NEC (705.4 ± 368.1 μg/g) versus suspected NEC (188.4 ± 119.8 μg/g) and controls (41.56 ± 11.03 μg/g; p < 0.001). SMA Doppler showed significantly higher PSV (93.32 ± 12.44 cm/s vs. 63.60 ± 10.40 cm/s, p < 0.001) and RI (0.85 ± 0.09 vs. 0.62 ± 0.07, p < 0.001) in confirmed NEC. FC had 100% sensitivity and specificity (AUC = 1.00, cutoff >147 μg/g) for NEC diagnosis. PSV (AUC = 0.998, cutoff >49 cm/s) and PI (AUC = 1.000, cutoff >0.91) also showed high diagnostic accuracy. Conclusion: The combination of SMA Doppler ultrasonography and fecal calprotectin measurement provides a promising approach for the early prediction of NEC in high-risk neonates. Integrating these biomarkers into routine screening protocols could enhance early detection, allowing for timely intervention and improved neonatal outcomes.