Changes in Cerebral and Visceral Blood Flow Velocities in Asphyxiated Term Neonates With Hypoxic-Ischemic Encephalopathy

Abstract

Objective. The purpose of this study was to evaluate changes in the Doppler blood flow velocity (BFV) in the cerebral and visceral arteries in asphyxiated term neonates. Methods. The BFV was measured in 47 asphyxiated and 37 healthy term neonates in the anterior cerebral artery, middle cerebral artery, basilar artery, internal carotid artery, celiac artery (CA), superior mesenteric artery (SMA), and renal artery (RA) up to the age of 60 to 149 days. Results. At the age of 12 to 120 hours after asphyxia, the mean BFV had increased, and the resistive index (RI) had decreased (P < .05) in all cerebral arteries in neonates with severe hypoxic-ischemic encephalopathy (HIE) compared with the control group. In neonates with severe HIE, the mean BFV in the RA had significantly decreased at the age of 3 to 240 hours, and the RI had increased at the age of 24 to 240 hours, normalizing by the age of 21 to 59 days compared with the control group (P < .05). In the SMA, a decreased mean BFV was found in neonates with severe HIE compared with those with mild to moderate HIE only at the age of 24 to 36 hours. In neonates with mild to moderate HIE, the mean BFV had increased in the SMA and CA compared with the control group at the age of 2 to 11.9 hours. Conclusions. A severe alteration of the cerebral and visceral BFV takes place during the first days after asphyxia in neonates with different severities of HIE. Key words: cerebral blood flow velocity; hypoxic-ischemic encephalopathy; neonate; sonography; visceral blood flow velocity. irth asphyxia remains a major cause of neonatal morbidity and infant mortality worldwide, with multiple-organ failure developing in 50% to 60% of severely asphyxiated infants. 1,2 Hypoxicischemic encephalopathy (HIE) occurring during the perinatal period is one of the most commonly recognized causes of severe long-term neurologic deficits in children.2 The severity of the encephalopathy predicts the risk of death and long-term neurodisability.3-5 The central nervous system is disturbed in 70% of neonates after severe birth asphyxia 6 ; however, asphyxia is likely to cause disturbances in a number of organ systems other than the brain. Renal involvement occurred in 40% to 50%, pulmonary involvement in 25%, cardiac involvement in 25% to 30%, and gastrointestinal involvement in 30% of the cases of asphyxiated term neonates. 1,6 Others showed a higher proportion of neonates with renal, pulmonary, cardiac, and liver dysfunction: in 58% to 88% of

Splanchnic Circulation in Small for Date Newborns

“…At the same time, hypotrophic newborns have increased values of parameters characterizing the resistance of vascular bed in the superior mesenteric artery. The blood flow velocity in the superior mesenteric artery is reduced by birth asphyxia, patent ductus arteriosus, dopamin, dobutamin, indomethacin, caffein and umbilical arterial catheter (12,13). Similar conclusions are reported in the study performed by Martinussen, (1996) (10).…”

Physiological changes in blood flow velocities in the superior mesenteric and coeliac artery in healthy term fetuses and newborns during perinatal period

“…They were clinically stable and in good condition without signs of cardiac or circulatory compromise. Exclusion criteria were the presence of birth asphyxia requiring resuscitation after delivery (Apgar score 7 in the first minute), the presence of congenital anomalies and clinical evidence of any cardiac abnormalities, as these alter visceral blood flow velocities [11,12]. Written informed consent was obtained from each pregnant woman enrolled and from both parents of the infant, thereafter.…”

Changes in carotid blood flow after unilateral perinatal arterial ischemic stroke

“…In addition to the effects of vasoactive metabolites, other mechanisms, including neurogenic vasodilation, have been proposed (14). Previous studies in infants focused mainly on changes in CBF velocity (CBFV) measured using Doppler ultrasonography in infants with neonatal encephalopathy (NE) (15)(16)(17). Higher mean CBFV values have been found during the first days after asphyxia in infants with severe NE as compared with a control group of infants with mild to moderate NE and healthy infants, the maximum values of CBFV being seen at 36-72 h after birth (16,17).…”

“…Previous studies in infants focused mainly on changes in CBF velocity (CBFV) measured using Doppler ultrasonography in infants with neonatal encephalopathy (NE) (15)(16)(17). Higher mean CBFV values have been found during the first days after asphyxia in infants with severe NE as compared with a control group of infants with mild to moderate NE and healthy infants, the maximum values of CBFV being seen at 36-72 h after birth (16,17). More recently, using perfusionweighted imaging, Wintermark et al reported observing initial hypoperfusion followed by hyperperfusion on days 2 and 3 in infants who develop brain injury after NE (18).…”