Postnatal middle cerebral artery Dopplers in growth-restricted neonates
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ORIGINAL ARTICLE
Postnatal middle cerebral artery Dopplers in growth-restricted neonates Mohan B Krishnamurthy 1 & Pramod Pharande 1 & Gillian Whiteley 2 & Ryan J Hodges 3 & Atul Malhotra 1,4 Received: 13 July 2019 / Revised: 2 October 2019 / Accepted: 28 November 2019 # Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract This prospective observational study compared the middle cerebral artery (MCA) Doppler characteristics of FGR neonates (N = 20) with abnormal antenatal Dopplers, with those of appropriately grown (AGA) neonates (N = 20), in the immediate postnatal period. MCA peak systolic velocity (PSV), end-diastolic velocity (EDV), pulsatility index (PI), and resistive index (RI) were measured on day 1 and day 3. MCA PSV and EDV values were not significantly different between FGR (mean (SD) gestation: 31.4 (3.1) weeks, weight 1205 (463) grams) and AGA (31.1 (3.0) weeks; 1668 (490) grams) groups, on day 1 and day 3. Both FGR (30.85 (10.02) vs. 42.12 (9.16) cm/s, p = 0.007) and AGA groups (31.77 (9.32) vs. 42.0 (8.98) cm/s, p = 0.001) showed a significant increase in MCA PSV, but only the FGR group showed significant increase in EDV values (7.01 (4.23) vs. 11.78 (4.98), p = 0.002) from day 1 to day 3. This was associated with significant differences in RI (0.72 (0.10) vs. 0.79 (0.07), p = 0.01) and PI (1.36 (0.47) vs. 1.73 (0.4), p = 0.01) values between FGR and AGA groups on day 3. Conclusion: Significant differences in MCA resistive and pulsatility indices were noted in the first few days of life of FGR neonates with abnormal antenatal Doppler as compared with AGA neonates. This may suggest a delayed transition or persistence of cerebral redistribution in FGR neonates. What is Known: • FGR infants have increased risk of neonatal morbidity and mortality, and long-term neuro-disabilities. • Antenatal Doppler Ultrasound is the most common modality used to assess fetal growth restriction. What is New: • Antenatally detected abnormal cerebral Dopplers may persist during the neonatal period in growth-restricted neonates. • Early cerebral Doppler values may be a useful marker to identify “at risk” growth-restricted neonates..
Keywords Fetal growth restriction . Peak systolic velocity . End-diastolic velocity . Pulsatility index . Resistive index Abbreviations ACA Anterior cerebral artery AGA Appropriate for gestational age CPR Cerebro-placental ratio
EDV FGR GA IVH
End-diastolic velocity Fetal growth restriction Gestational age Intraventricular hemorrhage
Communicated by Patrick Van Reempts * Atul Malhotra [email protected] Mohan B Krishnamurthy [email protected] Pramod Pharande [email protected]
1
Monash Newborn, Monash Children’s Hospital, 246, Clayton Road, Melbourne, VIC 3168, Australia
2
Diagnostic Imaging, Monash Health, 246, Clayton Road, Melbourne, VIC 3168, Australia
3
Department of Obstetrics and Gynaecology, Monash University, 246, Clayton Road, Melbourne, VIC 3168, Australia
4
Department of Paediatrics, Monash University, 246, Clayton Road, Melbour
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