Severe Birth Asphyxia and Abnormal Cerebral Blood‐flow Velocity

Levene, Malcolm I.; Fenton, Alan; Evans, David H.; Archer, L. N. J.; Shortland, David; Gibson, Neil

doi:10.1111/j.1469-8749.1989.tb04020.x

Cited by 93 publications

(37 citation statements)

References 16 publications

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“…Vários estudos sobre a dopplerfl uxometria pela ultra-sonografi a transfontanela em recém-nascidos têm sido realizados, demonstrando um declínio fi siológico progressivo do IR com a idade cronológica 16 , e alterações dos valores de IR em condições patológicas, como por exemplo na hipóxia [17][18][19][20][21][22][23][24][25] . Porém este pare- Em estudos correlatos utilizando o Doppler transfontanela para a avaliação da EHI em RN a termo, não foram excluídos RN com alterações morfológi-cas detectadas pela USTF [17][18][19][20][21][22][23] .…”

Section: Discussionunclassified

“…Porém este pare- Em estudos correlatos utilizando o Doppler transfontanela para a avaliação da EHI em RN a termo, não foram excluídos RN com alterações morfológi-cas detectadas pela USTF [17][18][19][20][21][22][23] . Observaram diminuição dos valores de IR em RN com EHI grave ou moderada, associando os valores menores ou iguais a 0,55, no período de seis horas a cinco dias de vida, a um pior prognóstico como morte no período neonatal e disfunção neurológica grave a longo prazo.…”

Section: Discussionunclassified

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Relação entre índice de resistência obtido pela ultra-sonografia Doppler transfortanela e o neurodesenvolvimento até o primeiro ano de vida em recém-nascidos a termo com encefalopatia hipóxico-isquêmica leve e moderada

arcia

Monteiro

Freire

2007

Arq. Neuro-Psiquiatr.

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RESUMO -Objetivo: Avaliar a relação do índice de resistência (IR) obtido pela ultra-sonografia Doppler transfontanela com o neurodesenvolvimento até um ano de idade, em recém-nascidos (RN) a termo com encefalopatia hipóxica-isquêmica (EHI) leve a moderada, secundária à asfixia intra-parto. Método: Estudo prospectivo em 20 RN com EHI leve a moderada, IR elevado no primeiro exame de Doppler, e sem doenças associadas ou anormalidades morfológicas cerebrais. Foram realizados exames seriados bimensais de Doppler transfontanela a partir do sétimo dia de vida, e avaliações clínicas mensais do neurodesenvolvimento no primeiro ano de vida. Resultados: Houve normalização progressiva dos valores de IR até o último exame realizado. Cinco pacientes apresentaram normalização clínico-neurológica no período neonatal, após o primeiro exame de Doppler. Quinze lactentes apresentaram alterações neurológicas com resolução a partir do segundo trimestre de vida. Conclusão: Houve relação entre os períodos em que ocorreu a normalização dos valores de IR e a melhora clínica-neurológica. PALAVRAS-CHAVE: encefalopatia hipóxica-isquêmica, ultra-sonografia Doppler, recém-nascido, neurodesenvolvimento.Relation between the resistance index obtained by the transfontanellar Doppler ultrasonography and the neurological development until the first year of life in term infants with mild or moderate hypoxic-ischaemic encephalopathy ABSTRACT -Objective: To evaluate the relation between the resistance index (RI) obtained by transfontanellar Doppler ultrasonography, and the neurodevelopment until one year of life, at term newborns with mild or moderate hypoxic-ischaemic encephalopathy due to intrapartum asphyxia. Method: 20 term newborns, with mild or moderate hypoxic-ischemic encephalopathy, high values of resistance index in the first exam, and without cerebral morfologic abnormalities or other diseases. They were submitted to serial bimonthly transfontanellar Doppler ultrasonography, from the seventh day of life on, and monthly clinical neurodevelopment assessment until one year of life. Results: There was a progressive normalization of RI values until the last examination. In five cases there were clinical neurologic normalization in the neonatal period after the first Doppler exam. Fifteen infants presented neurologic abnormalities, with normalization after the second trimester of life. Conclusion: There was a relation between the normal RI values with the normalization of the clinical assessment.

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Section: Discussionunclassified

Relação entre índice de resistência obtido pela ultra-sonografia Doppler transfortanela e o neurodesenvolvimento até o primeiro ano de vida em recém-nascidos a termo com encefalopatia hipóxico-isquêmica leve e moderada

arcia

Monteiro

Freire

2007

Arq. Neuro-Psiquiatr.

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“…12,20,21 Increased CBFV in the cerebral circulation by the age of 12 h in infants with severe HIE or poor outcome has been reported. 20,22 Increased CBFV from 24 to 72 h has been taken as a sign of permanent brain damage with poor prognosis in asphyxiated infants, [12][13][14] and the present results confirm the findings concerning increased CBFVs.…”

Section: Discussionmentioning

confidence: 99%

“…CTG has a high sensitivity but low specificity for fetal hypoxia or asphyxia. 11 Increased cerebral blood flow velocity (CBFV) and resistive index reduced below 0.55 by pulsed Doppler ultrasonography, have been associated with poor outcome in birth asphyxia assessed at the age from 24 to 72 h. [12][13][14] We have previously shown a strong association of increased systolic CBFV in the anterior cerebral (ACA) or in the basilar (BA) arteries at around 24 h of age with adverse neurological outcome at the age of 1 year, whereas reduced resistive index failed to show association with poor outcome (submitted/unpublished data). In this study, we sought to analyse the obstetric parameters, biochemical asphyxia markers, HIE symptoms or their combinations, in predicting the neurological outcome at 1 year in full-term asphyxiated infants.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2011

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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.

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“…Using these definitions, the incidence of birth asphyxia lies between 2.9 and 9/1000 deliveries Levene. 6 Katz and Bowes stated that "when normal FHR patterns are found with meconium stained amniotic fluid the neonatal outcome is similar to neonates with clear fluid. 7 Similarly, in infants with meconium stained amniotic fluid with antepartum signs of distress: neonatal outcomes are similar to those of non-meconium stained infants with similar FHR abnormalities.…”

Section: Pathogenesismentioning

confidence: 99%

Study on Meconium stained fluid-perinatal outcome

Harikumar

Rajesh

2018

Int J Reprod Contracept Obstet Gynecol

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Background: The objective of this study is to find a correlation between the presence of MSAF in mothers with co- morbidities like PIH and GDM and to study the fetal heart variability in cases with MSAF and the significance of an admission test. This study also throws a light on the perinatal outcomes associated with MSAF.Methods: 100 women in labor with Meconium stained amniotic fluid were taken in this study. An admission test was done for all patients, along with continuous fetal heart monitoring was done in the presence of MSAF. Effect of thin and thick meconium on fetus was studied. The cases with maternal co-morbidities were closely monitored along with the mode of delivery, Apgar score, birth weight, resuscitation of baby was studied. All the newborns born through meconium stained liquor were followed up to one week of neonatal life.Results: Out of a total of 100 cases there was 60 cases with thick meconium with a non-reactive NST seen in 65% cases with thick MSAF and 32.5% cases with thin MSAF. 79% of cases with MSAF underwent emergency LSCS. The neonatal complications were more with thick meconium stained liquor accounting to 28.3% incidence of MAS, 23.3% of sepsis, 3.3%of pneumonitis and 21.7% of birth asphyxia.Conclusions: This study ascertained the need for an admission test and continuous CTG monitoring in cases detected to have meconium stained amniotic fluid. Co-morbidities like GDM did have a small role to play though the incidence was not very high. The neonatal complications were more common among cases with thick meconium stained liquor and probably the use of procedures like amnioinfusion can bring down the incidence of perinatal morbidity along with the rate of caesarean sections.

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Severe Birth Asphyxia and Abnormal Cerebral Blood‐flow Velocity

Cited by 93 publications

References 16 publications

Relação entre índice de resistência obtido pela ultra-sonografia Doppler transfortanela e o neurodesenvolvimento até o primeiro ano de vida em recém-nascidos a termo com encefalopatia hipóxico-isquêmica leve e moderada

Relação entre índice de resistência obtido pela ultra-sonografia Doppler transfortanela e o neurodesenvolvimento até o primeiro ano de vida em recém-nascidos a termo com encefalopatia hipóxico-isquêmica leve e moderada

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

Study on Meconium stained fluid-perinatal outcome

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