Diagnostic and predictive value of Doppler ultrasound for evaluation of the brain circulation in preterm infants: a systematic review

Camfferman, Fleur; Goederen, Robbin de; Govaert, Paul; Dudink, Jeroen; Bel, Frank van; Pellicer, Adelina; Cools, Filip

doi:10.1038/s41390-020-0777-x

Cited by 34 publications

(28 citation statements)

References 83 publications

(104 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, there is no clear evidence to support the routine determination of resistance index or other Doppler parameters in the cerebral arteries to predict IVH in preterm infants. 12,13 For the above reasons, we pay attention performing venous Doppler measurements instead of arterial ones.…”

Section: Discussionmentioning

confidence: 99%

Fluctuations in internal cerebral vein and central side veins of preterm infants

Ikeda

Ito

Mikami

et al. 2021

Pediatrics International

View full text Add to dashboard Cite

Background: Studies on the acute management of extremely low birthweight (ELBW) infants reveal a high incidence of intraventricular hemorrhage (IVH) in infants with high-grade internal cerebral vein perfusion waveform fluctuations. In this prospective observational study we investigated the Doppler perfusion waveform fluctuations in the great cerebral vein, straight sinus, and internal cerebral veins of ELBW infants. Methods: We evaluated perfusion waveforms after birth every 12 h until 120 h in 73 ELBW infants (<1,000 g) at our hospital. Fluctuations were categorized into four patterns of increasing magnitude, Grades 0-3. Results: The maximum grades of perfusion waveform fluctuations of the internal cerebral veins were 0, 1, 2, and 3 detected in 12, 38, 13, and 10 infants, respectively; those of the great cerebral vein were 0, 1, 2, and 3 detected in 5, 17, 20, and 31 infants, respectively; and those of the straight sinus were 0, 1, 2, and 3 detected in 1, 5, 17, and 50 infants, respectively. Only one of 803 simultaneous measurements of the Doppler perfusion waveforms showed stronger fluctuations of the peripheral vein than those of the central side veins. Intraventricular hemorrhage was associated with high-grade fluctuations in the internal cerebral veins but not in the great cerebral vein or straight sinus. Conclusions: Most infants had high-grade fluctuations in the great cerebral vein and straight sinus, with lower grade fluctuations in the internal cerebral vein, but IVH was not associated with those markers. Intraventricular hemorrhage was correlated with high-grade fluctuations only in the internal cerebral veins.

show abstract

Section: Discussionmentioning

confidence: 99%

Fluctuations in internal cerebral vein and central side veins of preterm infants

Ikeda

Ito

Mikami

et al. 2021

Pediatrics International

View full text Add to dashboard Cite

show abstract

“…A recent systematic review found no clear evidence for using single Doppler-derived parameters to predict neurological outcome in premature infants, although some evidence relates elevated RI in cerebral arteries to a hemodynamically significant ductus arteriosus (DA). 39 We did not assess the state of the DA at the time of testing. Spontaneous closure of DA is associated with decreased PI and increased systolic and diastolic BFV in both the anterior and middle cerebral artery.…”

Section: Discussionmentioning

confidence: 99%

Effects of tilt on cerebral hemodynamics measured by NeoDoppler in healthy neonates

et al. 2021

View full text Add to dashboard Cite

Background Today, there are conflicting descriptions of how neonates respond to tilt. Examining physiologic responses of cerebral blood flow velocities (BFVs) in challenging situations like a tilt requires equipment that can cope with positional changes. We aimed to characterize how healthy term neonates respond to mild cerebral hemodynamic stress induced by a 90° tilt test using the recently developed NeoDoppler ultrasound system. Methods A small ultrasound probe was fixated to the neonatal fontanel by a cap, and measured cerebral BFV in healthy neonates during and after a 90° head-up tilt test, five min in total, at their first and second day of life. Unsupervised k-means cluster analysis was used to characterize common responses. Results Fifty-six ultrasound recordings from 36 healthy term neonates were analyzed. We identified five distinct, immediate responses that were related to specific outcomes in BFV, heart rate, and pulsatility index the next two min. Among 20 neonates with two recordings, 13 presented with different responses in the two tests. Conclusions Instant changes in cerebral BFV were detected during the head-up tilt tests, and the cluster analysis identified five different hemodynamic responses. Continuous recordings revealed that the differences between groups persisted two min after tilt. Impact NeoDoppler is a pulsed-wave Doppler ultrasound system with a probe fixated to the neonatal fontanel by a cap that can measure continuous cerebral blood flow velocity. Healthy neonates present with a range of normal immediate cerebral hemodynamic responses to a 90° head-up tilt, categorized in five groups by cluster analysis. This paper adds new knowledge about connection between immediate responses and prolonged responses to tilt. We demonstrate that the NeoDoppler ultrasound system can detect minute changes in cerebral blood flow velocity during a 90° head-up tilt.

show abstract

“…This may be explained by the increased angle of insonation in premature newborns, when evaluating the descending aorta in the subcostal window, compared to a term newborn where one may have more amplitude of manipulation of the probe. During Doppler acquisition, angle of insonation between the sampled vessel and the ultrasound beam must be minimized to avoid imprecision in estimating the Doppler shift [ 18 , 19 ]. As such, the beam should interrogate the corresponding flow in a parallel fashion, as much as feasible [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

End-organ saturations correlate with aortic blood flow estimates by echocardiography in the extremely premature newborn – an observational cohort study

2021

View full text Add to dashboard Cite

Background Near-infrared spectroscopy (NIRS) measures of cerebral saturation (Csat) and renal saturation (Rsat) in extreme premature newborns may be affected by systemic blood flow fluctuations. Despite increasing clinical use of NIRS to monitor tissue saturation in the premature infant, validation of NIRS measures as a correlate of blood flow is still needed. We compared echocardiography (ECHO) derived markers of ascending aorta (AscAo) and descending aorta (DesAo) blood flow with NIRS measurements obtained during the ECHO. Methods Newborns < 29 weeks’ gestation (2013–2017) underwent routine NIRS monitoring. Csat, Rsat and systemic saturation at the time of ECHO were retrospectively analyzed and compared with Doppler markers of aortic flow. Renal and cerebral fractional tissue oxygen extraction (rFTOE and cFTOE, respectively) were calculated. Mixed effects models evaluated the association between NIRS and Doppler markers. Results Forty-nine neonates with 75 Csat-ECHO and 62 Rsat-ECHO observations were studied. Mean post-menstrual age was 28.3 ± 3.8 weeks during the ECHO. Preductal measures including AscAo velocity time integral (VTI) and AscAo output were correlated with Csat or cFTOE, while postductal measures including DesAo VTI, DesAo peak systolic velocity, and estimated DesAo output were more closely correlated with Rsat or rFTOE. Conclusions NIRS measures are associated with aortic blood flow measurements by ECHO in the extremely premature population. NIRS is a tool to consider when following end organ perfusion in the preterm infant.

show abstract

Diagnostic and predictive value of Doppler ultrasound for evaluation of the brain circulation in preterm infants: a systematic review

Cited by 34 publications

References 83 publications

Fluctuations in internal cerebral vein and central side veins of preterm infants

Fluctuations in internal cerebral vein and central side veins of preterm infants

Effects of tilt on cerebral hemodynamics measured by NeoDoppler in healthy neonates

End-organ saturations correlate with aortic blood flow estimates by echocardiography in the extremely premature newborn – an observational cohort study

Contact Info

Product

Resources

About