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Severe birth asphyxia and abnormal cerebral blood-flow velocity
M I Levene1, A C Fenton, D H Evans
1University Department of Paediatrics and Child Health, General Infirmary of Leeds.
Developmental Medicine and Child Neurology
|August 1, 1989
Summary
Abnormal cerebral blood-flow velocity (CBFV) in infants with postasphyxial encephalopathy (PAE) strongly predicts poor outcomes. High or low CBFV measurements indicate severe injury, with elevated CBFV suggesting irreversible damage.
Area of Science:
- Neonatal Neurology
- Pediatric Ultrasound
- Cerebral Hemodynamics
Background:
- Postasphyxial encephalopathy (PAE) is a serious condition in newborns following oxygen deprivation.
- Assessing cerebral blood-flow velocity (CBFV) is crucial for understanding brain injury in these infants.
- Ultrasound provides a non-invasive method to measure CBFV and related indices.
Purpose of the Study:
- To evaluate the utility of ultrasound-measured cerebral blood-flow velocity (CBFV) in predicting outcomes for term infants with PAE.
- To identify abnormal CBFV patterns associated with severe neurological injury and mortality in PAE.
Main Methods:
- Ultrasound assessment of CBFV was performed on 34 term infants with PAE and 126 healthy controls.
- CBFV measurements were categorized as normal, low (<-2 SD), or high (>=2 SD) relative to controls.
- Pourcelot Resistance Index (PRI) was also analyzed in conjunction with CBFV.
Main Results:
- 17 infants with PAE exhibited high CBFV and 4 had low CBFV; all had severe PAE.
- High CBFV was associated with a Pourcelot Resistance Index (PRI) < 0.55.
- CBFV measurements <-2 SD or >3 SD had a 94% positive predictive value for death or severe impairment.
Conclusions:
- Abnormal CBFV patterns, particularly high CBFV, are significant indicators of poor neurological outcomes in infants with PAE.
- High CBFV may represent vasoparalysis and irreversible cerebral injury.
- Ultrasound-derived CBFV measurements offer valuable prognostic information for PAE management.