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Does abnormal Doppler on cranial ultrasound predict disability in infants with hypoxic-ischaemic encephalopathy? A
Chandra Rath1,2, Shripada Rao1,2,3, Pradeep Suryawanshi4
1King Edward Memorial Hospital, Western Australia, Australia.
Insights
Abnormal cerebral blood flow velocity (CBFV) on ultrasound accurately predicts poor outcomes in infants with hypoxic-ischaemic encephalopathy (HIE) not receiving cooling therapy. Its predictive value is reduced during or after cooling.
Area of Science:
- Neonatal Neurology
- Pediatric Neuroimaging
- Clinical Ultrasound Applications
Background:
- Hypoxic-ischaemic encephalopathy (HIE) is a major cause of neonatal brain injury.
- Predicting long-term disability in HIE infants is crucial for timely intervention.
- Cranial ultrasound parameters like resistive index and cerebral blood flow velocity (CBFV) are potential biomarkers.
Purpose of the Study:
- To systematically review and meta-analyze the predictive accuracy of abnormal resistive index or CBFV for long-term disability in HIE infants.
- To compare predictive performance across different eras (pre- and during therapeutic hypothermia).
Main Methods:
- Systematic review and meta-analysis of 26 studies.
- Included studies compared developmental outcomes of HIE infants with normal versus abnormal ultrasound findings.
- Data from 15 studies were pooled for meta-analysis.
Main Results:
- High sensitivity and specificity for predicting death or severe disability were observed for abnormal resistive index or CBFV in the pre-therapeutic hypothermia era.
- In the therapeutic hypothermia era, specificity remained high when measurements were taken before cooling, but sensitivity decreased.
- Evidence quality was rated as 'low' or 'very low'.
Conclusions:
- Abnormal resistive index or CBFV shows potential for predicting poor outcomes in non-cooled HIE infants.
- Cerebral Doppler ultrasound may be useful in cooled infants if performed prior to therapeutic hypothermia initiation.
- The utility of these ultrasound measures is limited when performed during or after cooling.
Aim:
To evaluate whether abnormal resistive index or cerebral blood flow velocity (CBFV) on cranial ultrasound predicts disability (≥1 year) in infants with hypoxic-ischaemic encephalopathy (HIE).
Method:
This was a systematic review and meta-analysis of studies comparing developmental outcomes of infants with HIE with normal versus abnormal resistive index or CBFV.
Results:
Twenty-six studies were included (pre-therapeutic hypothermia era, 20; therapeutic hypothermia era, six). Data from 15 studies (pre-therapeutic hypothermia, 10; therapeutic hypothermia, five) were available for meta-analysis. Pooled sensitivity and specificity, summary area under the receiver operating characteristic curve, and diagnostic odds ratio of resistive index or CBFV for predicting 'death or severe disability' were as follows. Pre-therapeutic hypothermia era: 0.83 (95% confidence interval [CI] 0.45-0.97) and 0.92 (95% CI 0.74-0.98), 0.94 (95% CI 0.92-0.96), 54 (95% CI 7-391). Therapeutic hypothermia era (measurements before therapeutic hypothermia): 0.62 (95% CI 0.41-0.80) and 0.96 (95% CI 0.88-0.99), 0.93 (95% CI 0.89-0.94), 23 (95% CI 6-91). Therapeutic hypothermia era (measurements during/after therapeutic hypothermia): 0.51 (95% CI 0.24-0.78) and 0.83 (95% CI 0.73-0.90), 0.81 (95% CI 0.78-0.85), 5 (95% CI 2-13). Overall Grading of Recommendations Assessment, Development and Evaluation (GRADE) rating of evidence was 'low' or 'very low'.
Interpretation:
Low-level evidence suggests that abnormal resistive index or CBFV can predict death or disability with high sensitivity and specificity in infants with HIE who are not cooled. The specificity of these tests was high when performed before starting cooling in infants who received therapeutic hypothermia.
What This Paper Adds:
Cerebral doppler ultrasound may be useful in predicting death or disability in infants with hypoxic-ischaemic encephalopathy who are not cooled. Cerebral doppler ultrasound may also be useful in infants who are cooled, if done before starting cooling. Cerebral doppler ultrasound may not be useful when performed during or after completing cooling.
