Cerebral blood flow velocities and cerebrovascular resistance in normal‐term neonates in the first 72 hours

Forster, Danielle Elizabeth; Koumoundouros, Emmanuel; Saxton, Virginia; Fedai, Gabrielle; Holberton, James

doi:10.1111/jpc.13663

Cited by 23 publications

(23 citation statements)

References 31 publications

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“…We found that oscillations and the Doppler velocity waveforms from different blood vessels at different depths had similar patterns. This is in line with previous studies demonstrating a good correlation between flow indices in the anterior and in the middle cerebral artery, 15,33 as well as between the right and left great vessels. 34 These findings support that identifying exactly the same vessel is not essential to assess the cerebral circulation.…”

Section: New Features Obtained With Neodopplersupporting

confidence: 93%

“…Whether or not flow indices are good indicators to assess cerebral hemodynamics remains controversial. 11,33,35,36 In neonatology, RI has been used to predict outcome in infants with neonatal encephalopathy. A low RI (<0.55) has been associated with poor neurological outcome, 37 but this association appears weaker during therapeutic hypothermia.…”

Section: New Features Obtained With Neodopplermentioning

confidence: 99%

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NeoDoppler: New ultrasound technology for continuous cerebral circulation monitoring in neonates

et al. 2019

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BACKGROUND: There is a strong need for continuous cerebral circulation monitoring in neonatal care, since suboptimal cerebral blood flow may lead to brain injuries in preterm infants and other critically ill neonates. NeoDoppler is a novel ultrasound system, which can be gently fixed to the anterior fontanel and measure cerebral blood flow velocity continuously in different depths of the brain simultaneously. We aimed to study the feasibility, accuracy, and potential clinical applications of NeoDoppler in preterm infants and sick neonates. METHOD: Twenty-five infants born at different gestational ages with a variety of diagnoses on admission were included. The probe was placed over the anterior fontanel, and blood flow velocity data were continuously recorded. To validate NeoDoppler, we compared the measurements with conventional ultrasound; agreement was assessed using Bland-Altman plots. RESULTS: NeoDoppler can provide accurate and continuous data on cerebral blood flow velocity in several depths simultaneously. Limits of agreement between the measurements obtained with the two methods were acceptable. CONCLUSION: By monitoring the cerebral circulation continuously, increased knowledge of cerebral hemodynamics in preterm infants and sick neonates may be acquired. Improved monitoring of these vulnerable brains during a very sensitive period of brain development may contribute toward preventing brain injuries.

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Section: New Features Obtained With Neodopplersupporting

confidence: 93%

Section: New Features Obtained With Neodopplermentioning

confidence: 99%

NeoDoppler: New ultrasound technology for continuous cerebral circulation monitoring in neonates

et al. 2019

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“…As a quality control, we compared our arterial blood flow velocity data with data from Forster et al (2018) assessing term neonates within their first 3 days of life and found an overall consistency: ACA PSV 36.3 ± 6.6 cm/s (our data: 29.6 ± 6.2 at t0/36.8 ± 8.5 at t1); ACA EDV 12.4 ± 3.9 cm/s (9.3 ± 2.8 at t0/8.9 ± 3.3 at t1); RI 0.67 ± 0.06 (0.66 ± 0.09 at t0/0.68 ± 0.08 at t1). GCV data had to be compared to the data from Figueroa-Diesel et al (2008) studying growth restricted fetuses: maximum flow 8.2 ± 5.5 cm/s (our data: sagittal 4.0 ± 0.8, coronal 4.1 ± 1.0 at t0).…”

Section: Discussionmentioning

confidence: 99%

Supine vs. Prone Position With Turn of the Head Does Not Affect Cerebral Perfusion and Oxygenation in Stable Preterm Infants ≤32 Weeks Gestational Age

2018

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Intraventricular hemorrhage (IVH) is a frequent major damage to the brain of premature babies ≤32 weeks gestational age, and its incidence (20–25%) has not significantly changed lately. Because of the intrinsic fragility of germinal matrix blood vessels, IVH occurs following disruption of subependymal mono-layer arteries and is generally attributed to ischemia-reperfusion alterations or venous congestion, which may be caused by turn of the head. Therefore, supine position with the head in a midline position is considered a standard position for preterm infants during their first days of life. We asked whether a change in body position (supine vs. prone) linked with a turn of the head by 90° in the prone position would change blood flow velocities and resistance indices in major cerebral arteries and veins of stable premature babies at two different time points (t0, day of life 2, vs. t1, day 9). Moreover, we assessed cerebral tissue oxygenation (cStO2) by near-infrared spectroscopy and determined correlations for changes in velocities and oxygenation. Twenty one premature infants [gestational age 30 (26–32) weeks] with sufficiently stable gas exchange and circulation were screened by ultrasonography and near-infrared spectroscopy. Peak systolic and end-diastolic blood flow velocities in the anterior cerebral arteries (29 ± 6 m/s vs. 28 ± 7 peak flow at t0, 36 ± 8 vs. 35 ± 7 at t1), the basilar artery, the right and the left internal carotid artery, and the great cerebral vein Galen (4.0 ± 0.8 m/s vs. 4.1 ± 1.0 maximum flow at t0, 4.4 ± 0.8 vs. 4.4 ± 1.0 at t1) did not show significant differences following change of body and head position. Also, there were no differences in cStO2 (83 ± 7% vs. 84 ± 7 at t0, 76 ± 10 vs. 77 ± 11 at t1) and in vital signs such as heart rate and blood pressure. We conclude that change in body position with turn of the head in the prone position does not elicit significant alterations in cerebral blood flow velocities or in oxygenation of cerebral tissues. Maturational changes in arterial flow velocities and cStO2 are not correlated. For this subgroup of premature infants at low risk of IVH our data do not support the concept of exclusive preterm infant care in supine position.

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“…RI is calculated by (PSV-EDV)/PSV. PI is the difference in pulsatile flow velocities divided by time-averaged velocity (15). PI is calculated by (PSV-EDV)/V mean in which V mean is the time-averaged velocity of the PWD in cm s −1 .…”

Section: Ultrasound Protocolmentioning

confidence: 99%

Feasibility of Doppler Ultrasound for Cortical Cerebral Blood Flow Velocity Monitoring During Major Non-cardiac Surgery of Newborns

et al. 2021

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Background and Aim: Newborns needing major surgical intervention are at risk of brain injury and impaired neurodevelopment later in life. Disturbance of cerebral perfusion might be an underlying factor. This study investigates the feasibility of serial transfontanellar ultrasound measurements of the pial arteries during neonatal surgery, and whether perioperative changes in cerebral perfusion can be observed and related to changes in the perioperative management.Methods: In this prospective, observational feasibility study, neonates with congenital diaphragmatic hernia and esophageal atresia scheduled for surgical treatment within the first 28 days of life were eligible for inclusion. We performed transfontanellar directional power Doppler and pulsed wave Doppler ultrasound during major high-risk non-cardiac neonatal surgery. Pial arteries were of interest for the measurements. Extracted Doppler ultrasound parameters were: peak systolic velocity, end diastolic velocity, the resistivity index and pulsatility index.Results: In 10 out of 14 patients it was possible to perform perioperative measurements; the others failed for logistic and technical reasons. In 6 out of 10 patients, it was feasible to perform serial intraoperative transfontanellar ultrasound measurements with directional power Doppler and pulsed wave Doppler of the same pial artery during neonatal surgery. Median peak systolic velocity was ranging between 5.7 and 7.0 cm s−1 and end diastolic velocity between 1.9 and 3.2 cm s−1. In patients with a vasoactive-inotropic score below 12 the trend of peak systolic velocity and end diastolic velocity corresponded with the mean arterial blood pressure trend.Conclusion: Perioperative transfontanellar ultrasound Doppler measurements of the pial arteries are feasible and provide new longitudinal data about perioperative cortical cerebral blood flow velocity.Trial Registration:https://www.trialregister.nl/trial/6972, identifier: NL6972.

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Cerebral blood flow velocities and cerebrovascular resistance in normal‐term neonates in the first 72 hours

Cited by 23 publications

References 31 publications

NeoDoppler: New ultrasound technology for continuous cerebral circulation monitoring in neonates

NeoDoppler: New ultrasound technology for continuous cerebral circulation monitoring in neonates

Supine vs. Prone Position With Turn of the Head Does Not Affect Cerebral Perfusion and Oxygenation in Stable Preterm Infants ≤32 Weeks Gestational Age

Feasibility of Doppler Ultrasound for Cortical Cerebral Blood Flow Velocity Monitoring During Major Non-cardiac Surgery of Newborns

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