Medidas do índice de resistência ao Doppler craniano em recém-nascidos pré-termo com lesão da substância branca cerebral

Abstract

Objective: To investigate whether the resistance index (RI) within the first 72 hours of life of newborn infants with cerebral white matter lesion (WML) is correlated with the adverse outcome of WML.Methods: Retrospective study. Newborn infants with WML were identified based on cranial ultrasound results, and those with Doppler imaging and RI measurement were selected. The newborn infants were placed in three groups: low (< 0.61), normal (0.61-0.85) or high (> 0.85) RI. The sample was analyzed as a whole at first and then stratified according to birth weight.Results: According to the RI, cerebral blood flow was abnormal in 46 (68.7%) patients, low in 42 (62.7%), and high in four (6%). Among those with a low RI, 15 (35.7%) had an adverse outcome, with ultrasonographic signs of cerebral atrophy in 10 (23.8%) and intraventricular hemorrhage in five (11.9%) patients. The four newborn infants with a high RI also had an adverse outcome, one (25%) with signs of cerebral atrophy and three (75%) with intraventricular hemorrhage. No statistically significant differences were observed between RI groups and the group with a fatal outcome. Conclusion:The study showed that abnormal RI within the first 72 hours was associated with healing complications in newborn infants with cerebral WML. Abnormal RI results were not correlated with the fatal outcome. Therefore, RI is an important parameter that should be measured in newborn infants. Cranial Doppler resistance index measurement in preterm newborns with cerebral white matter lesion

Aplicação clínica da ultrassonografia craniana com Doppler em neonatos prematuros de muito baixo peso

“…As regards the cases of PVL found in the present study, changes were observed in the upper value of RI in 50% of the cases at transcranial Doppler US performed between the first and fifth days of life. In a study investigating RI only in the anterior cerebral artery at the first 72 hours of life of 53 neonates with mean gestational age of 30.4 weeks and birth-weight < 1500 g, lesion in the white matter and alteration in the maximum RI were observed in only 5.6% of the neonates (14) . Such investigation was performed in neonates with gestational age and weight similar to those in the present study, but Doppler was performed in only one artery, with a lower prevalence than in the present study.…”

“…The results demonstrated that the clinical application of this imaging method is extremely useful in the evaluation of premature neonates, particularly when performed up to the fifth day of life, as it contributes with valuable data for a better therapeutic approach and neurological development of such pediatric patients. Additionally, life support measures adopted as early as possible are essential to avoid worsening of hypoxic-ischemic and infec-tious lesions, as well as to allow the followup of these patients (14) .…”