Background

The dynamic nature of neonatal hypoxic-ischemic encephalopathy (HIE) after birth necessitates reliable biomarkers to identify infants with evolving brain injury. This prospective cohort aims to use serial Doppler ultrasonography (US) to measure cerebral blood flow velocity and resistance index (RI) to help detect the time and evolution of the clinical encephalopathy.

Methods

A total of 60 neonates were enrolled all ≥36 weeks’ gestation with perinatal acidemia, defined as a blood gas pH ≤ 7.0 or base deficit ≥16 mmol/L and encephalopathy including a matched control group without encephalopathy. Each neonate received one to three serial Doppler recordings starting at six to 24 hours of life. Mean RI ≤ 0.55 was considered abnormal.

Results

Mean RIs obtained shortly after birth were significantly lower with increasing severity of encephalopathy. On the first Doppler recordings, abnormal mean RIs were seen in 11 of 18 (61%) neonates with mild, 13 of 17 (76%) with moderate, and two of two (100%) with severe HIE. Of the neonates with mild HIE and abnormal mean RIs, congruity abnormal amplitude electroencephalography (45%), brain magnetic resonance imaging (45%), and abnormal head ultrasound (44%) are here reported.

Conclusions

Doppler measurements can provide bedside adjunct biomarkers indicating the time and severity of neonatal HIE.

中文翻译：

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早期使用经颅多普勒超声对新生儿脑病进行分层

背景

新生儿缺氧缺血性脑病 (HIE) 出生后的动态特性需要可靠的生物标志物来识别患有不断发展的脑损伤的婴儿。该前瞻性队列旨在使用连续多普勒超声（US）来测量脑血流速度和阻力指数（RI），以帮助检测临床脑病的时间和演变。

方法

共有 60 名新生儿在所有 ≥ 36 周的妊娠中被纳入围产期酸血症，定义为血气 pH ≤ 7.0 或碱缺乏 ≥ 16 mmol/L 和脑病，包括无脑病的匹配对照组。每个新生儿在出生后 6 到 24 小时开始接受 1 到 3 次连续多普勒记录。平均 RI ≤ 0.55 被认为是异常的。

结果

随着脑病严重程度的增加，出生后不久获得的平均 RI 显着降低。在第一次多普勒记录中，18 名新生儿中的 11 名 (61%) 轻度 HIE，17 名中的 13 名 (76%) 中度新生儿和 2 名 (100%) 重度 HIE 新生儿中的平均 RI 异常。在轻度 HIE 和平均 RI 异常的新生儿中，此处报道了一致性异常幅度脑电图 (45%)、脑磁共振成像 (45%) 和头部超声异常 (44%)。

结论

多普勒测量可以提供床边辅助生物标志物，指示新生儿 HIE 的时间和严重程度。