Neonatal Cerebral Circulation in Relation to Neurosonography and Neurological Outcome: A Pulsed Doppler Study

Abstract

In the pathogenesis of neonatal intracranial pathology and adverse neurologic outcome, severe instability of the neonatal cerebral circulation might play an important role. To examine this hypothesis the relationship was explored between intracranial pathology as detected by neurosonography during the first week of life, changes in cerebral blood flow velocity (CBFV) as measured by Doppler ultrasound in the same period and neurologic outcome, as measured by standardized tests during the first year of life.

A group of 128 infants born after a pregnancy duration between 25 2/7 and 32 6/7 weeks was studied.

In 40 % of the infants, the time of occurrence of both types of intracranial pathology was within 1 hour after birth. No relation could be demonstrated between this occurrence and CBFV. Also after the appearance of intracranial pathology no specific changes in CBFV were seen. CBFV was associated with neurological outcome at term age. However, CBFV did not predict outcome of neurological examination at 6 and 12 months of corrected age. Intracranial hemorrhages were associated with abnormal neurological outcome at all assessments. Ischemic lesions were only associated with adverse outcome at 12 months of age.

Abbreviations

CBFV = cerebral blood flow velocity
ED = echodensities
ICH = intracranial hemorrhages
MAP = mean arterial blood pressure
MCA = middle cerebral artery
PIVH = peri-intraventricular hemorrhage
V _mean = time averaged mean velocity
TcpCO₂ = transcutaneous pCO₂ = time averaged mean velocity TcpCC>2 = transcutaneous pC02nk

Key words

Pulsed Doppler ultrasound - Cerebral blood flow velocity - Neonatal brain damage - Neurological outcome - Neurosonography