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Transfontanellar duplex brain ultrasonography resistive indices as a prognostic tool in neonatal hypoxic-ischemic encephalopathy before and after treatment with therapeutic hypothermia

Journal of Perinatology volume 36, pages 202–206 (2016)Cite this article

Subjects

Abstract

Objective:

Prior to therapeutic hypothermia (that is, cooling), transfontanellar duplex brain sonography resistive indices (RI) were studied as a bedside non-invasive measures of cerebral hemodynamics in neonates who suffered from hypoxic-ischemic encephalopathy (HIE). We compared pre- and post-cooling RI values and examined the relationships between RI values and specific long-term neurodevelopmental outcomes.

Study Design:

Transfontanellar duplex brain sonography, including RI, were obtained for 28 neonates prior to cooling and for 20 neonates following cooling. All RI values were sampled in the anterior cerebral artery at the beginning of each ultrasound study. Neurodevelopmental assessment was conducted between ages 20–32 months with the Mullen Scale of Early Learning. The relationships between pre- and post-cooling RI and cognitive and motor outcomes were studied.

Result:

Neonates with RI values <0.60 prior to and following cooling were more likely to die or have severe neurodevelopmental disability by ages 20–32 months than those with RI>0.60. Lower RI values were associated with specific neurodevelopmental deficits in motor skill attainment.

Conclusion:

Pre- and post-cooling transfontanellar duplex brain sonography RI values may be a useful prognostic tool, in conjunction with other clinical information, for neonates diagnosed with HIE. The results of this study suggest that further study of the prognostic value of RI values for short- and long-term outcomes is warranted.

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Acknowledgements

GJG was supported by NIH grant NICHD 5T32HD007414-18 during writing of this manuscript. VJB was supported by NIH grant NINDS K12-NS001696 during the writing of this manuscript. FJN was supported by NIH HD070995 during the writing of this manuscript.

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Authors and Affiliations

  1. Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA

    G J Gerner

  2. Neurosciences Intensive Care Nursery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    G J Gerner, V J Burton, A Poretti, T Bosemani, E Cristofalo, A Tekes, C Parkinson, M Allen, T A G M Huisman, F J Northington & M V Johnston

  3. Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA

    V J Burton, E Cristofalo, M Leppert, M Allen & M V Johnston

  4. Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Section of Pediatric Neuroradiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    A Poretti, T Bosemani, A Tekes, D Seyfert & T A G M Huisman

  5. Division of Perinatal-Neonatal Medicine, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    E Cristofalo, C Parkinson, M Allen & F J Northington

  6. Hugo Moser Research Institute, Kennedy Krieger Institute, Baltimore, MD, USA

    M V Johnston

  7. Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    M V Johnston

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  1. G J Gerner
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  2. V J Burton
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  3. A Poretti
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  11. T A G M Huisman
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Correspondence to G J Gerner.

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Gerner, G., Burton, V., Poretti, A. et al. Transfontanellar duplex brain ultrasonography resistive indices as a prognostic tool in neonatal hypoxic-ischemic encephalopathy before and after treatment with therapeutic hypothermia. J Perinatol 36, 202–206 (2016). https://doi.org/10.1038/jp.2015.169

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