INTRODUCTION: Perinatal asphyxia is the most common cause of neurologic injury to the neonate and may lead to significant morbidity and mortality. Cerebral artery Doppler ultrasonography has been used for prediction of outcome after perinatal asphyxia in recent decades.
OBJECTIVE: We investigated whether cerebral artery Doppler ultrasonography is 1 of earliest markers of neurodevelopmental outcome.
METHODS: Cerebral artery Doppler ultrasonography was performed serially via temporal window during the first week of life in 24 asphyxiated neonates in our NICU from 1999 to 2007. The resistive indexes (RI) and blood flow velocities in the cerebral arteries of the circle of Willis were obtained. Neurodevelopmental outcomes were evaluated during follow-up.
RESULTS: Four patterns of cerebral artery Doppler ultrasonography were identified: pattern 1, normal RI with normal cerebral blood flow (6 neonates); pattern 2, normal RI with high cerebral blood flow (4 neonates); pattern 3, high RI after 48 hours of life (8 neonates); and pattern 4, low RI with high cerebral blood flow (6 neonates). Patterns 3 and 4 demonstrated grave prognosis, with severe cerebral palsy or mortality reported in more than 3 of 4 of neonates with either pattern, whereas all neonates with pattern 1 had favorable outcomes, free of delayed development or neurologic sequelae.
CONCLUSIONS: Cerebral artery Doppler ultrasonography is an early useful tool for predicting neurodevelopmental outcome after perinatal asphyxia. The outcomes turned out to be grave once abnormal RIs were detected, either low or high, indicating severe neurologic damage after asphyxia.
Submitted by Haung-Chi Lin
- Copyright © 2008 by the American Academy of Pediatrics