Role of cerebral artery Doppler velocimetry in neonatal hypoxic ischemic encephalopathy
DOI:
https://doi.org/10.18203/2349-3291.ijcp20221073Keywords:
HIE, Neurosonogram, RI, PIAbstract
Background: Hypoxic ischemic encephalopathy (HIE) is a brain injury that prevents adequate blood flow to the infant’s brain. As compared to MRI and CT scan, neurosonogram is easily available, cost effective and easily reproducible, and is not associated with any radiation exposure or sedation. Therefore, the present study was conducted to assess the role of neurosonogram changes in grey scale and Doppler findings in evaluation of HIE.
Methods: It was a hospital-based case control study conducted over a period of one year in which 35 full term neonates born after 37 weeks of gestation with birth weight more than 2.5 kg and clinical evidence of HIE based on Sarnat and Sarnat classification were selected as cases. The 35 neonates other than HIE were matched by age and sex with the cases within 72 hours of birth were labelled as control.
Results: On doppler USG both resistive index (RI) and pulsatilitiy index (PI) in anterior cerebral artery (ACA) as well as middle cerebral artery (MCA) were significantly lower in HIE subjects compare to control group while peak systolic velocity (PSV) and end diastolic velocity (EDV) were significantly higher in HIE subjects. There was significant association of RI, PI and EDV with severity of HIE.
Conclusions: Spectral doppler imaging has very high sensitivity and specificity in diagnosis as well as grading of HIE. Therefore, it is recommended that in all neonates with clinical suspicion of HIE, neurosonogram along with spectral doppler of cranial arteries should be done for evaluation of HIE.
References
Finer NN, Robertson CM, Peters KL, Coward JH. Factors affecting outcome in hypoxic-ischemic encephalopathy in term infants. Am J Dis Child. 1983;137:21-5.
Salas J, Tekes A, Hwang M, Northington FJ, Huisman TAGM. Head Ultrasound in Neonatal Hypoxic-Ischemic Injury and Its Mimickers for Clinicians: A Review of the Patterns of Injury and the Evolution of Findings Over Time. Neonatology. 2018;114(3):185-97.
Chao CP, Zaleski CG, Patton AC. Neonatal Hypoxic Ischemic Encephalopathy: Multimodality Imaging Findings. Radiographics. 2006;26:S159-72.
Rutherford MA, Pennock JM, Dubowitz LMS. Cranial ultrasound and magnetic resonance imaging in hypoxic-ischemic encephalopathy: a comparison with outcome. Dev Med Child Neurol. 1994;36:813-25.
PS Pinto, Tekes, S Singhi, FJ Northington, C Parkinson, and TAGM Huisman: White-Gray matter echogenicity ratio and resistive index: sonographic bedside markers of cerebral hypoxic-ischemic injury/edema. J Perinatol. 2012;32(6):448-53.
Ilves P, Talvik R, Talvik T. Changes in Doppler ultrasonography in asphyxiated term infants with hypoxic-ischaemic encephalopathy. Acta Paediatr. 1998;87:680-4.
Eken P, Toet MC, Groendaal F, De Vries LS. Predictive value of early neuroimaging, pulsed Doppler and neurophysiology in full term infants with hypoxic-ischaemic encephalopathy. Arch Dis Child. 1995;73:F75-80.
Rao PT, Kishore MS, Manasa G, Naidu CS. Prediction of Neurological Outcome in High-Risk Neonates: Prospective Study. Indian J Neonat Med Res. 2018;6(1): PO06-9.
Stark JE, Seibert JJ. Cerebral artery Doppler ultrasonography for prediction of outcome after perinatal asphyxia. J Ultrasound Med. 1994;13:595-600.
Daven JR. Cerebral Vascular Resistance in Premature Infants. Am J Dis Child. 1983;137:328-31.
Archer LN, Levene M, Evans DH. Cerebral artery Doppler ultrasonography for prediction of outcome after perinatal asphyxia. Lancet. 1986;2(8516):1116-8.
Ilves P, Talvik R, Talvik T. Changes in Doppler ultrasonography in asphyxiated term infants with hypoxic-ischaemic encephalopathy. Acta Paediatr. 1998;87:680-4.
