Necrotizing enterocolitis in infants born to women with severe early preeclampsia and absent end-diastolic umbilical artery Doppler flow velocity waveforms

The aim of this study was to determine the prevalence of necrotizing entero colitis (NEC) in infants born to a homogeneous group of women with severe p reeclampsia before 34 weeks' gestation and who had absent end-diastolic umb ilical artery Doppler flow (AEDF) or normal umbilical Doppler flow velociti es (NUFV). A total of 242 infants were entered into the study. The mean bir th weight was 1260.5 g (SD = 339) and the mean gestational age 30.5 weeks ( SD = 2.0). Sixty-eight (28%) infants had AEDF, 43 (18%) had umbilical arter y Doppler flow velocities between the 95th and 99th percentile, and 131 (54 %) had NUFV. Forty-one (18%) infants developed NEC, of whom 20 (8%) develop ed definite and advanced NEC (grade 2 and 3). Of these, 16(80%) had grade 2 and 4(20%) had grade 3. Twenty-one (8%) infants developed suspected NEC (g rade 1). The mean onset of grade 1 NEC (7.2 days) occurred significantly ea rlier than in those with grades 2 and 3 NEC (18.7 and 23.3 days, respective ly). Pi the 21 infants with grade 1 NEC, 10 (48%) had AEDF and 9 (43%) had NUFV. None of the infants with grades 2 or 3 NEC had AEDF. We conclude that although chronically hypoxemic fetuses born to women with severe early ons et preeclampsia and AEDF respond by redistributing blood flow to vital orga ns and away from the gut; the intestinal compromise is of insufficient magn itude to induce intestinal necrosis or NEC. Enteral feeding, however, shoul d be introduced cautiously in infants with AEDF, as so-called suspected NEC developed significantly more often in these infants.