Obstetric parameters and Doppler findings in cerebral circulation as predictors of 1 year neurodevelopmental outcome in asphyxiated infants

Abstract

Objective: To establish the association of cardiotocography (CTG) and other obstetric parameters with pulsed Doppler findings in cerebral arteries during the first day of life, and to compare the cerebral artery Doppler with other determinants of asphyxia in predicting 1-year neurological outcome in asphyxiated full-term infants.Study Design: Cerebral blood flow velocity (CBFV) were measured from the anterior cerebral (ACA) and basilar (BA) arteries in 30 asphyxiated and 30 healthy-term infants using pulsed Doppler ultrasonography at approximately 24 h of age. CTG, cord artery pH, Apgar scores, biochemical asphyxia markers and symptoms of hypoxic-ischemic encephalopathy (HIE) were compared with the Doppler findings in respect of the ability to predict the outcome, defined by death or impaired neurological performance at 1 year of age.Result: In all, 20% of the asphyxiated infants but none in the control group had increased peak systolic CBFVs (mean þ 3 s.d.) in the ACA or BA. The sensitivity of increased systolic CBFV to predict abnormal outcome in the asphyxia group was 83%, specificity 95% and the sensitivity of the combination of HIE grade from 2 to 3 and increased systolic CBFV in the ACA or BA was 100% and specificity was 95%, respectively. Pathological CTG and low cord artery pH or low Apgar scores showed low predictive power. Conclusion:Grade from 2 to 3 HIE and the systolic CBFV (mean þ 3 s.d.) in the ACA or BA by Doppler ultrasound seemed to predict the outcome in asphyxiated infants at 1 year of age better than CTG, acid basement status, Apgar scores or asphyxia markers. If an increase of more than þ 3 s.d. in the systolic CBFV does not occur within the first 24 h of life, a good 1-year neurological outcome may be anticipated.

Sex differences in cerebral blood flow following chorioamnionitis in healthy term infants

“…Julkunen also found that increased CBF by Doppler was a better predictor of adverse neurological outcomes at 1 year of age in asphyxiated infants as compared with other markers. 40 Elevated CBF in HC males may either directly contribute to lower scores in males or indirectly serve as a marker of fetal brain inflammation. Although correlations did exist between blood flow parameters and BSID scores for long-term outcomes, these data are speculative and not as strong as the primary outcome of sex-specific CBF data.…”

Intrauterine inflammation alters cardiopulmonary but not cerebral hemodynamics during open endotracheal tube suction in preterm lambs

“…High cerebral blood flow velocity has been demonstrated as a sensitive predictor of neonatal mortality and poor neurological outcome at 12 mo of age (29,30); thus, the cerebral circulatory consequences of open ETT suction may result in brain injury. ETT suctioning is most frequently performed during the first 72 h after delivery, with a single infant undergoing as many as six suction procedures during this period (19).…”

The Role of Transcranial Grayscale and Doppler Ultrasound Examination in Diagnosis of Neonatal Hypoxic-ischemic Encephalopathy

“…These findings support earlier reports that TCD could be used as a diagnostic and prognostic modality for infants with severe HIE [31] and can be used to guide medical therapy and management of cerebral hypoperfusion, which is associated with higher morbidity and mortality rates [31] . Moreover, Julkunen et al [32] found that TCD diagnosis of HIE Grade 2-3 and estimation of ACA-blood flow velocity can predict the outcome in asphyxiated infants better than cardiotocography, acid basement status, Apgar scores, or asphyxia markers. Thereafter, Lovett et al [33] documented favorable neurologic outcomes of patients who had TCD-detected near normal flow velocity with intermittently intact cerebral autoregulation.…”