A Prospective Study on the Importance of Colour Doppler Neuro Sonography in Assessing the Short -Term Prognosis among Full-Term Neonates with Perinatal Asphyxia
Author(s): KV Pugalendhi Raja*, K Rangasamy, Prathiba, Arpitha and Nivetha
Abstract
Aim & objective: The aim of the study was to determine the role of blood flow parameters evaluated by color Doppler ultrasonography in neonates with birth asphyxia and correlate it with the short term prognostic outcome mortality. Methods: Color Doppler ultrasound was performed at the bedside within the first 24 hours after birth. Measurements were done with a 2–5 MHz convex or phased array transducer of computed sonography system. The transducer will be positioned on the anterior fontanelle to perceive hemodynamic parameters of bilateral middle cerebral arteries, and anterior cerebral artery including peak Systolic Flow Velocity (PSFV), End-Diastolic Flow Velocity (EDFV), Time-averaged Mean Flow Velocity (TMFV), Pulsatility Index (PI) and Resistive Index (RI). All the indices were measured over three complete cardiac cycles. Results: In our study most of the mothers belonged to 21-30 years age group. Among them 68 percent of the babies were delivered by normal labour and rest by LSCS. Among our study group 79 percent of the babies weighed between 2-3 kg .Course of labour were uneventful in most of the cases. Endotracheal Intubation was required in 18 babies, bag and mask ventilation in 21 babies and chest compression in 3 babies. Hospital stay of more than 10 days was required in only a few babies. Commonest diagnosis was birth asphyxia followed by HIE and MAS. Total of18 infants died in our study population. Most common cause of death was severe birth asphyxia. Ventilator support was required in 16 neonates. Inotropes were used in 18 babies. Resistive Index (RI) and Pulsatility Index (PI) seem to be increased in babies with poor prognosis. Similarly PSFV and EDFV were decreased in babies with poor prognosis. Conclusion: In conclusion, the present study confirms a role for Cranial Doppler measurements like RI,PI,PSFV and EDFV, in conjunction with other clinical information, as a safe and cost-efficient method for prognostication of outcome in neonatal HIE. Considering the prognostic potential of RI in neonates with HIE, it is desirable that neonatologists get familiar with the optimal usage of this imaging modality, especially in settings lacking sophisticated neuroimaging techniques. This study results also opens the gates for further research with more specific end points to further confirm the importance of Cranial Doppler and its factors as a tool to assess the severity and mortality.