This observational study aimed to evaluate Doppler velocimetry parameters in the anterior cerebral artery (ACA), superior mesenteric artery (SMA), and main renal artery (RA) in neonates diagnosed with late-onset neonatal sepsis (LONS) and assess its association with clinical complications. Conducted in a tertiary neonatal intensive care unit in India in 2022, the study included 20 neonates with LONS and 20 gestational age-matched neonates as controls. Baseline clinical characteristics and sepsis indicators were recorded, followed by serial Doppler ultrasounds performed on days 1, 3, and 7 after the onset of clinical sepsis. Velocimetry measurements, including peak systolic velocity, resistive index, pulsatility index, and end-diastolic velocity, were obtained from the ACA, SMA, and RA.
The results revealed significant differences in Doppler parameters between neonates with LONS and the control group. Specifically, those with LONS showed elevated peak systolic velocities and increased resistive and pulsatility indices in all three arteries (ACA, SMA, and RA), alongside lower end-diastolic velocities in the ACA and RA (P < 0.05). These vascular changes indicate increased resistance to blood flow in cerebral, splanchnic, and renal circulation among septic neonates, potentially compromising blood supply to these vital organs. Additionally, LONS was associated with notable clinical morbidities: 45% of neonates experienced intraventricular hemorrhage (IVH), 50% developed necrotizing enterocolitis (NEC), and 10% had acute kidney injury (AKI). However, subgroup analysis of Doppler parameters within the LONS cohort showed no significant differences between neonates with and without these complications.
In conclusion, LONS may alter cerebral, intestinal, and renal perfusion in preterm neonates, increasing the risk of severe morbidities such as IVH, NEC, and AKI. Doppler ultrasound offers valuable insight into these hemodynamic changes, which could inform early intervention strategies in neonatal intensive care settings.
