Abstract
Background and aims: Intrauterine growth restriction (IUGR) increases the risk for adverse neurodevelopment. While prenatal prediction of mortality is now greatly improved, prediction of neurodevelopmental morbidity remains limited. We explored the value of fetal cardiovascular Doppler parameters to predict neonatal brain damage and abnormal neurobehavior in IUGR.
Methods: Doppler parameters (DV pulsatility index (PI), MPI, and AoI PI) were performed in a cohort of IUGR preterm (< 35 weeks) fetuses with abnormal umbilical artery Doppler. Neonates underwent several cranial ultrasound scans and the Neonatal-Behavioral-Assessment-Scale (NBAS) at 40 weeks of corrected age. Isolated and combined value of cardiovascular parameters to predict interventricular hemorrhage (IVH), periventricular leukomalacia (PVL), basal ganglia damage (BGD), and abnormal NBAS were evaluated by multiple logistic regression and decision tree analysis. Gestational age (GA), middle cerebral artery, and umbilical artery were included as covariates.
Results: Of 106 IUGR fetuses, 90 survivors were studied. Mean GA at birth was 30.9 weeks. Retrograde flow in the DV and the AoI were significantly associated with brain injury with adjusted odds ratios (OR) of 8.6 and 4.1 respectively. Decision tree analysis combining these parameters discriminated high (67%), moderate (52%), and low risk (12%) for any brain lesion at 40 weeks. Retrograde AoI PI identified a high risk of abnormal NBAS in habituation (OR 14.4) and attention capacity (OR 12.6).
Conclusions: Prediction of neonatal neurological morbidity might be greatly improved by fetal cardiovascular evaluation, influencing prenatal and neonatal management. The association of prenatal cardiovascular parameters with long-term neurodevelopment merits further investigation.
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Tenorio, V., Cruz-Martinez, R., Figueras, F. et al. 200 Neurological Damage Prediction by Fetal Doppler Parameters in Intrauterine Growth Restricted Preterm Infants. Pediatr Res 68 (Suppl 1), 104–105 (2010). https://doi.org/10.1203/00006450-201011001-00200
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DOI: https://doi.org/10.1203/00006450-201011001-00200