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SUMMARY Transcutaneous Doppler ultrasound measurements were made of the superior mesenteric artery of 22 preterm infants (mean birth weight 600-2580 g) to investigate the response of intestinal blood flow to feeding. Analysis of the data in relation to milk intake showed a significant change in peak velocity and mean velocity; peak velocity before feeding increased from a mean baseline value of 34 cm/s in fasting infants to 46 cm/s when less than 50 g milk/kg body weight a day were given, and up to 56 cm/s when 50 g or more of milk/kg body weight a day were given. The corresponding values for mean velocity were 10, 15, and 22 cm/s, respectively. The pulsatility index decreased from 0.94 to 0.90 and 0-86 as milk volumes were increased. This investigation showed characteristic changes in the response of intestinal blood flow to feeding: 15 minute peak velocity and mean velocity rose significantly 15, 45, and 90 minutes after feeding, whereas the pulsatility index fell. Flow rate peaked 45 minutes after feeding. The duplex scan technique (real time scanner combined with pulsed Doppler equipment) allows precise localisation of a defined volume within the superior mesenteric artery from which the Doppler flow signal is sampled. This study describes the method of measuring blood flow in the superior mesenteric arteries of premature infants. 'Normal' values and characteristic changes in flow patterns of 22 preterm neonates were correlated with enteral feeding and the amount of milk given; peak velocity, mean velocity (integral of the maximum velocities over cardiac cycle), and pulsatility index were analysed. Patients and methodsThe data obtained from 22 preterm infants (gestational age range 25-36 weeks, weight at examination range 600-2850 g, and postnatal age range 1 hour-30 days) were evaluated. At ultrasound examination the general condition of the infants was good; oxygen and carbon dioxide tensions and blood pressures were normal, and their abdomens were free of gas. There were no signs or symptoms of necrotising enterocolitis. Eight patients with hyaline membrane disease required mechanical ventilation. Doppler investigations were carried out in these

In 25 healthy newborns transcutaneous Doppler ultrasound measurements (Duplex-Scan) of flow velocities in the superior mesenteric artery were performed to define normal values and to investigate the response of intestinal blood flow to feeding. The diameter of the vessel was measured from real-time and M-mode imaging: mean value 3.2 mm. The analysis of the flow patterns before and after feeding revealed a significant change of the blood flow with increase of the peak velocity (Vp) (from 57 +/- 3.1 cm/sec to 97 +/- 11.5 cm/s) and the mean velocity (Vm) (from 22 +/- 1.6 cm/s to 41 +/- 4.1 cm/s). The pulsatility index decreased from 0.85 in the fasting baby to 0.73 45 min after feeding. The Vm was correlated with the post natal age and depended upon the quantity and quality of the meals. Neonates when fed only with tea/glucose 5% or small amounts of milk in the first 24 h, showed a fasting Vm of about 17-18 cm/s. Neonates older than two days who were fed with increasing amounts of milk showed a mean pre feeding Vm of 30 +/- 3.8 cm/s.

Changes of mortality and neurological morbidity in 351 very low birth-weight infants cared for in the neonatal intensive care unit of the Children's Hospital Tübingen during the years 1977 to 1983 are reported. The main finding was a survival rate increasing from 69.5% in 1977-79 to 76.6% in 1982-83 and a coinciding frequency of severe neurological sequelae decreasing from 9.2%-3.7%. The incidence of minor neurodevelopmental problems remained unchanged. However, mortality after discharge was found to be increased during the period observed. In conclusion, the intensification of neonatal intensive care in our hospital did not only reduce mortality but also the rate of severe neurological sequelae, thus not only survival rate but also the quality of survival could be improved.