Splanchnic Circulation in Small for Date Newborns

Open access


Hypotrophic newborn is a newborn with birth weight below the 5th percentile weight of corresponding gestational age. Hypotrophic infants have higher morbidity and mortality in comparison with eutrophic neonates. A higher incidence of hypoglycemia, polycythemia, hyperbilirubinemia, thrombocytopenia, perinatal asphyxia and caesarean section occurs typically in hypotrophic newborns. Both, intrauterine hemodynamic dysbalance and centralization of circulation due to hypotrophy cause decreased blood flow to the splanchnic circulation after the birth. There was observed a lower increase in blood flow through the coeliac artery and superior mesenteric artery in comparison with eutrophic newborns during the first postnatal week. These facts are likely to be associated with a higher frequency of abdominal problems and necrotizing enterocolitis.

  • 1. Mandruzzato G. Intrauterine growth restriction (IUGR): Guidelines for definition, recognition and management. Arch Perinat Med 2008; 14 (4): 7 - 8.

  • 2. Kolarovszká H. Hodnotenie prietoku krvi obličkami hypotrofických novorodencov pomocou dopplerovskej sonografie, Martin, 2005, PhD thesis on Jessenius medical faculty of Comenius University in Martin.

  • 3. Višňovský J. Vyšetrenie cirkulácie v pôrodníctve. Martin: Osveta; 2002.

  • 4. Hernandez - Andrade E, Figueroa - Diesel H, Jansson T, Rangel - Nava H, Gratacos E. Changes in regional fetal cerebral blood flow perfusion in relation to hemodynamic deterioration in severely growth restricted fetuses. Ultrasound Obstet Gynecol 2008; 32: 71 - 76.

  • 5. Mari G, Abuhamad AZ, Uerpairojkit B, Martinez E, Copel JA. Blood flow velocity waveforms of the abdominal arteries in appropriate - and small - for - gestational - age fetuses. Ultrasound Obstet Gynecol 1995; 6: 15 - 18.

  • 6. Korszun P, Dubiel M, Breborowicz G, Danska A, Gudmudsson S. Fetal superior mesenteric blood flow velocimetry in normal and high - risk pregnancy. J Perinat Med 2002; 30: 235 - 241.

  • 7. Dubiel M, Kozber H, Debniak B, Breborowicz GH, Marsál K, Gudmudsson S. Fetal and placental power Doppler imaging in normal and high - risk pregnancy. Eur J Ultrasound 1999; 9: 223.

  • 8. Gudmudsson S, Dubiel M, Kozber H, Ropacka M, Breborowicz GH, Marsál K. Power Doppler signals of fetal brain and lung blood flow in normal and high - risk pregancies. Prenat Neonatal Med 1999; 4: 282.

  • 9. Maruyama K, Koizumi T. Superior mesenteric artery blood flow velocity in small for gestational age infants of very low birth weight during the early neonatal period. J Perinat Med 2001; 29: 64 - 70.

  • 10. Martinussen M, Brubakk A - M, Vik T, Yao AC. Mesenteric blood flow velocity and its relation to transitional circulatory adaptation in appropriate for gestational age preterm infants. Pediatr Res 1996; 39 (2): 275 - 280.

  • 11. Van Bel F, Van Zoeren D, Schipper J, Guit GL, Baan J. Effect of indomethacin on superior mesenteric artery blood flow velocity in preterm infants. J Pediatr 1990; 116: 965.

  • 12. Ilves P, Lintrop M, Talvik I, Maipuu L. Changes in cerebral and visceral blood flow velocities in asphyxiated term neonates with hypoxic - ischemic encephalopathy. J Ultrasound Med 2009; 28: 1471 - 1480.

  • 13. Hoodbhoy SA, Cutting HA, Seddon JA, Campbell ME. Cerebral and splanchnic hemodynamics after duct ligation in very low birth weight infants. J Pediatr 2009; 154: 196 - 200.

  • 14. Dave V, Brion LP, Campbell DE, Scheiner M, Raab C, Nafday SM. Splanchnic tissue oxygenation, but not brain tissue oxygenation, increases after feeds in stable preterm neonates tolerating full bolus orogastric feeding. J Perinatol 2009; 29: 231 - 218.

  • 15. Huang CHF, Tsai MCH, CHu CHH, Lee MY, Shih YL, CHeng SN. The influence of pacificier sucking on mesenteric blood flow in infants. Clin Pediatr 2003; 42: 543 - 546.

  • 16. Ganong WF. Regulation of gastrointestinal function. In : Ganong WF. Review of Medical Physiology. New York: McGraw - Hill; 1999. p. 459 - 491.

  • 17. Moss RL, Kalish LA, Duggan C, Johnston P, Brandt ML, Dunn JC, Ehrenkranz RA, Jaksic T, Nobuhara K, Simpson BJ et al. Clinical parameters do not adequately predict outcome in necrotizing enterocolitis: a multi - institutional study. J Perinatol 2008; 28: 665 - 674.

  • 18. Srinivasan PS, Brandler MD, D’ souza A. Necrotizing enterocolitis. Clin Perinatol 2008; 35: 251 - 272.

  • 19. Maťašova K. Neonatológia. Bratislava: Vydavateľstvo UK; 2012.

  • 20. Grave GD, Nelson SA, Walker WA, Moss RL, Dvorak B, Hamilton FA, Higgins R, Raju TN. New therapies and preventive approaches for necrotizing enterocolitis : report of a research planning workshop. Pediatr Res 2007; 62: 510 - 514.

  • 21. Nankervis CA, Giannone PJ, Reber KM. The neonatal intestinal vasculature: contributing factors to necrotizing enterocolitis. Semin Perinatol 2008; 32: 83 - 91.

  • 22. Dorling J, Kempley S, Leaf A. Feeding growth restricted preterm infants with abnormal antenatal Doppler results. Arch Dis Child Fetal Neonatal Ed 2005; 90: F359 - F363.

  • 23. Kempley ST, Gamsu HR, Vyas S, Nicolaides K. Effect of intrauterine growth retardation on postnatal visceral and cerebral blood flow velocity. Arch Dis Child 1991; 66: 1115 - 1118.

  • 24. Cortez J, Gupta M, Amaran A, Pizzino J, Sawhney M, Sood BG. Noninvasive evaluation of splanchnic tissue oxygenation using near - infrared spectroscopy in preterm neonates. J Matern Fetal Neonatal Med 2011; 24 (4): 574 - 582.

  • 25. Robel -Tillig E, Vogtmann C, Bennek J. Prenatal hemodynamic disturbances - patophysiological backround of intestinal motility disturbances in small for gestational age infants. J Pediatr Surg 2002; 12: 175 - 179.

  • 26. Fang S, Kempley ST, Gamsu HR. Prediction of early tolerance to enteral feeding in preterm infants by measurements of superior mesenteric artery blood flow velocity. Arch Dis Child Fetal Neonatal Ed 2001; 85: 42 - 45.

  • 27. Murdoch EM, Sinha AK, Shanmugalingam T, Smith GCS, Kempley ST. Doppler flow velocimetry in the superior mesenteric artery on the first day of life in preterm infants and the risk of neonatal necrotizing enterocolitis. Pediatrics 2006; 118: 1999 - 2003.

  • 28. Bora R, Mukhopadhyay K, Saxena AK, Jain V, Narang A. Prediction of feed intolerance and necrotizing enterocolitis in neonates with absent end diastolic flow in umbilical artery and the correlation of feed intolerance with postnatal superior mesenteric artery flow. J Matern Fetal Neonatal Med 2009; 22: 1092 - 1096.

  • 29. Pezzati M, Dani C, Tronchnin M, Filippi L, Rossi S, Rubaltelli FF. Prediction of early tolerance to enteral feeding by measurement of superior mesenteric artery blood flow velocity: appropriate - versus small - for - gestational - age. Acta Paediatr 2004; 93: 797 - 802.

  • 30. Bhatt AB, Tank PD, Barmade KB, Damania KR. Abnormal Doppler flow velocimetry in the growth restricted foetus as a predictor for necrotizing enterocolitis. JPGM 2002; 48 (3): 182 - 185.

  • 31. Baschat AA, Gembruch U, Reiss I, Gortner L, Weiner CP, Harman CR. Relationship between arterial and venous Doppler and perinatal outcome in fetal growth restriction. Ultrasound Obsted Gynecol 2000; 16: 407 - 413.

  • 32. Reber KM, Nankervis CA, Nowicki PT. Newborn intestinal circulation: physiology and pathophysiology. Clin Perinatol 2002; 29: 23 - 39.

Acta Medica Martiniana

The Journal of Comenius University in Bratislava

Journal Information


All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 9 9 9
PDF Downloads 4 4 4