ORIGINAL ARTICLE Serial Doppler velocimetry of mesenteric and portal flow in very-low-birth-weight preterm neonates with and without patent ductus arteriosus Larissa Sobral Cavalcanti 1 & Eduardo Just da Costa e Silva 1 & Ana Rodrigues Falbo 2 & José Natal Figueiroa 3 & Letícia Amorim Bezerra Barreto 4 & Inês Marabuco Lopes 4 & Lívia Lócio Rosado de Oliveira 4 & Thiago Xavier de Barros Correia 5 Received: 12 December 2019 /Revised: 12 March 2020 /Accepted: 22 April 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020 Abstract Background Very-low-birth-weight (VLBW) preterm neonates are vulnerable to patent ductus arteriosus (PDA), which might be related to high-resistance flow in the superior mesenteric artery (SMA), with decreased diastolic flow in situations of marked intestinal hypoperfusion. No previous studies have evaluated the portal vein and superior mesenteric vein (SMV) parameters to assess the PDA hemodynamic repercussions. Objective To assess mesenteric and portal flow in VLBW preterm neonates with or without PDA using serial Doppler ultraso- nography (US). Materials and methods We conducted a prospective longitudinal study on 61 VLBW preterm neonates submitted to 161 Doppler US exams, from 2 days to 20 days of age. Results All infants exhibited a progressive daily increase in the mean of the SMA diameter and systolic velocity, the portal vein diameter, the peak velocity, the mean velocity and the flow volume and of SMV diameter (P<0.05). The incidence of PDA was 37.7% (n=23) and infants with the disease revealed a smaller diameter, greater systolic velocity, lower diastolic velocity, and higher resistivity and pulsatility indices on SMA compared to those without PDA (P<0.05). Additionally, 47.8% (n=11) of infants with PDA exhibited absent or reversed end-diastolic flow in the SMA, and its resolution was seen among 54.5% (n=6) of these. Infants with PDA also exhibited lower values of portal vein diameter and flow volume and of SMV diameter (P<0.01). Conclusion Doppler US enhances the understanding of mesenteric and portal flow, including the effects of PDA. The study of SMV and portal vein flow is proposed as a new parameter in PDA evaluation. Keywords Doppler ultrasonography . Neonates . Patent ductus arteriosus . Portal vein . Prematurity . Superior mesenteric artery . Superior mesenteric vein . Very low birth weight Introduction Very-low-birth-weight (VLBW) preterm neonates, consid- ered those born weighing less than 1,500 g, exhibit high mor- bidity and mortality rates because of organ immaturity and higher vulnerability to diseases and their complications, among them patent ductus arteriosus (PDA) [1, 2]. The ductus arteriosus is a vessel that communicates be- tween the pulmonary artery and the aorta during the fetal period. At this period, the fetal lungs exhibit high vascular resistance and thus receive the smallest part of the right ven- tricular output. Most of this output is directed to the systemic circulation through the ductus arteriosus. Shortly after birth, with the onset of breathing, the pulmonary vascular resistance * Larissa Sobral Cavalcanti lasobral@hotmail.com 1 Department of Radiology, Professor Fernando Figueira Integral Medicine Institute (IMIP), 300 Coelhos St., Boa Vista – Recife, PE 50070-550, Brazil 2 Department of Paediatric Research, Professor Fernando Figueira Integral Medicine Institute (IMIP), Recife, PE, Brazil 3 Department of Statistics and Research, Professor Fernando Figueira Integral Medicine Institute (IMIP), Recife, PE, Brazil 4 Faculdade Pernambucana de Saúde (FPS), Recife, PE, Brazil 5 Agamenon Magalhães Hospital, Recife, PE, Brazil Pediatric Radiology https://doi.org/10.1007/s00247-020-04689-y