Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
Users Online: 425
 
About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Advertise Login 
     
ORIGINAL ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 1  |  Page : 52-56

A Study of reversal of diastolic blood flow in the middle cerebral artery using doppler ultrasound in the prognostication in sick neonates


1 Consultant Neonatologist, Department of Neonatology, Manipal Hospital, Bengaluru, Karnataka, India
2 DNB Neonatology Trainee, Department of Neonatology, Manipal Hospital, Bengaluru, Karnataka, India

Correspondence Address:
Dr. Iyer Harohallli Venkatesh
Manipal Hospital, Bengaluru, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcn.JCN_83_19

Rights and Permissions

Background: The cerebral circulation is maintained on the principle of brain uniqueness cerebral autoregulation. Many factors such as oxygen, carbon dioxide, and blood pressure play a major role in the smooth journey of cerebral circulation. There is no clear marker used to assess the impending mortality in sick neonates. The resistive index (RI) is a measure of pulsatile blood flow, reflecting the resistance to flow caused by microvascular bed. The RI of the cerebral vessels is used to know the amount of blood that is flowing in the brain. Increased cerebral blood flow reduces the RI and decreased flow increases the resistance and the brain stays between the two, and hence, the autoregulation is maintained. When the cerebral autoregulation is lost, the flow in the diastole reverses and helps in the prognostication. Objective and Design: A prospective cohort study was conducted between March 2017 and May 2018 catering to both inborn and outborn neonates at Manipal Hospital, Bengaluru, to determine the importance of reversal of diastolic flow of RI in the middle cerebral artery as a marker of mortality in sick neonates. Subjects and Interventions: We enrolled 22 sick neonates both term and preterm. Normal resistive indices in neonates were taken as 0.6–0.9. Method: The RI was manually assessed in the middle cerebral artery using pulsed-wave Doppler. The mean RI was calculated from the average peak systolic velocity and end-diastolic velocity of at least five sequential stable waveforms. The reversal of diastolic flow in the RI was determined by the retrograde flow of waveform during diastole. Univariate and multivariate analyses were performed to identify prognostic factors for the overall survival, which was depicted using Kaplan–Meier curve.P< 0.05 was considered statistically significant. Results: Neonates who had a reversal of diastolic flow had a poor mean survival of 1.3 h when compared to those patients who did not have a reversal of flow of 133.8 days (hazard ratio [HR] – 4.66; 95.% confidence interval [CI]: 1.250–16.96) which was statistically significant (P = 0.022). Furthermore, birth weight <1000 g had a mean survival of 29 days, whereas birth weight >2500 g had a mean survival of 104 days (HR – 0.96; 95% CI: 0.460–2.032) which also was statistically significant (P < 0.001). Conclusion: As determined by univariate and multivariate analyses, the reversal of diastolic flow in the cerebral artery can strongly be used as a surrogate marker for impending mortality in a sick neonate.


[FULL TEXT] [PDF]*
Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
  Search Pubmed for
  Search in Google Scholar for
Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)
 

 Article Access Statistics
    Viewed58    
    Printed0    
    Emailed0    
    PDF Downloaded20    
    Comments [Add]    

Recommend this journal