Clinical Value of Color Doppler Ultrasonography Measurements of Full-Term Newborns with Perinatal Asphyxia and Hypoxic Ischemic Encephalopathy in the First 12 Hours of Life and Long-Term Prognosis.

Abstract

The cerebral blood flow velocities (CBFV) of infants with perinatal asphyxia and hypoxic ischemic encephalopathy (HIE) in the first 12 hours of their lives have been the chief focus of our concern in this study. Cerebral ischemia which can develop in the earlier hours of HIE, and the detection and diagnosis of this condition with color Doppler ultrasonography (cD-USG) will be put into discussion. Twenty-three full-term newborn infants who had perinatal asphyxia and HIE together with a control group constituting twenty full-term newborn infants who produced no problems, were included in our study. All of the infants underwent cD-USG in the postpartum period of the first 12 hours (mean 8.4 hours). Measurements being based upon peak systolic velocity (PSV), end diastolic velocity (EDV) and Pouecelout's resistive index (RI) in anterior and middle cerebral arteries were conducted. The infants, having been discharged from the unit they were followed up for mean 9.8 months in the outpatient clinic. PSV and EDV counts in the postpartum first 12 hours of 23 infants who were detected to have HIE were found to be significantly lower compared to the control group, whereas RI counts were found to be significantly higher (p < 0.05). The counts obtained from the right and left cerebral arteries of the infants with HIE were found to be corraleted with each others. The neonates in the patient group were observed to have gone through this prognosis: Three of them died, three of them had cerebral palsy, one of them had infantile spasms, and three of them had developmental retardation. When we compared the CBFV of the 10 neonates who had poor prognosis, retrospectively with the other 13 neonates who had good prognosis, PSV and EDV were found to be significantly lower and RI significantly higher (p < 0.05). In the light of the data we have obtained, cD-USG can be considered to be a highly practical device in evaluating CBVF of the infants with HIE. A skillful detection of the decrease in cerebral blood flow which can develop in the postasphyxial first 12 hours and the prospective treatments being based upon this approach would contribute to the diagnosis, treatment and prognosis of such cases.

The value of ultrasonography and Doppler sonography in prognosticating long-term outcomes among full-term newborns with perinatal asphyxia

“…The study showed that subjects who on the first day were found to have significantly higher Vd values and lower RI values demonstrated severe impairment of mental development (P < 0.05). A number of researchers analyzed associations between blood flow parameters measured via Doppler sonography on the first days of life and long-term outcomes [23,24,[27][28][29]. Some researchers analyzed the significance of blood flow parameters measured during the first 12 h of life.…”

“…Kirimi et al investigated the relationship of blood flow parameters registered during the first 12 h after birth with neuromotor and mental development of 1-year-old children. They found that neonates whose Vs and Vd of cerebral blood flow were significantly lower, and R was significantly higher, were found to have cerebral palsy (CP) and impairment of the mental and neuromotor development (P < 0.003) [29]. Ilves et al found that in children with poor outcomes (death or marked disability), blood flow Vs and Vd values in the anterior and medial cerebral arteries recorded 12 AE 2 h after birth were significantly higher than those in the control group (P < 0.005).…”

Ultrasonic Assessment of Cerebral Blood Flow Changes During Ischemia-Reperfusion in 7-Day-Old Rats

“…We wondered whether 12-MHz ultrasound imaging could be feasible in cerebral vessels and could represent an accurate and reproducible alternative tool to monitor cerebral circulatory changes in rat pups occurring during cerebral ischemia as applied in humans. Indeed, the accuracy of this technique has been validated for comparison transcranial flow velocity and cerebral blood flow during focal ischemia in adult animals (Els et al 1999) and has been used in term human newborns with hypoxic-ischemic encephalopathy (Kirimi et al 2002). This noninvasive method could be repeated allowing longitudinal survey during the whole duration and at each step of the protocol.…”

Blood Flow Velocities in the Anterior Cerebral Artery and Basilar Artery in Asphyxiated Infants

“…Previous studies have shown that the measurements of cerebral blood flow velocities (CBFVs) in the anterior cerebral artery (ACA) and middle cerebral artery are valu-able for predicting the neurodevelopmental outcome in infants with intrapartum asphyxia. [4][5][6][7][8][9][10][11][12][13][14][15][16][17] However, little is known about cerebral blood flow in the basilar artery (BA) in asphyxiated infants. 15 The BA arises from the vertebral arteries and supplies the brain stem with oxygen-rich blood.…”