|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 3 | Page : 222-223
Remarks on postnatal brain color doppler ultrasound
Reza Gerami1, Amin Saburi2
1 Department of Radiology, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
2 Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
|Date of Submission||13-Mar-2020|
|Date of Decision||06-Jul-2020|
|Date of Acceptance||06-Jul-2020|
|Date of Web Publication||07-Aug-2020|
Dr. Amin Saburi
Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Mollasadra Street, Vanak Square, Tehran
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gerami R, Saburi A. Remarks on postnatal brain color doppler ultrasound. J Clin Neonatol 2020;9:222-3
We read one of your valuable recently published articles entitled “A study of reversal of diastolic blood flow in the middle cerebral artery using Doppler ultrasound in the prognostication in sick neonates” and found it with interesting idea.
In this study, the authors selected a prospective cohort of 22 sick neonates who were admitted to their tertiary care center and assessed with color Doppler ultrasound (CDU). Their results show that reverse diastolic wave of middle cerebral artery (MCA) has a significant relationship with survival, but there are some queries that should be considered to make a better conclusion.
First, there are no specific and defined exclusion/inclusion criteria. It should be fully defined which sick neonate were included and moreover the exclusion criteria are even more important in this case. If cases with the following situations are included, they have already possible abnormal changes in CDU: intrauterine growth restriction, twin-to-twin transfusion syndrome, anemia, complicated pregnancy, patent ductus arteriosus, left ventricular dysfunction, respiratory distress syndromes, and maturity.
Therefore, these and other confusing factors (such as underlying disorders, APGAR score, hypoxic injuries, hydrocephaly, and other intra/extra cranial pathologies) should be considered and their possible effects should be eliminated with regression test.
Although they mentioned that “Higher RI had an adverse outcome which was similar to Argollo et al.,” there is no data about resistive index (RI) of cases and its relation with the outcome. Furthermore, CDU indexes are not fully assessed, with some of them such as RI, pulsatility index, peak systolic velocity, and time averaged mean flow velocity having critical role on general and cerebral neonate health assessment. As Krishnamurthy et al. reveal, “Significant differences in MCA resistive and pulsatility indices were noted in the first few days of life of fetal growth restriction neonates with abnormal antenatal Doppler as compared with appropriately grown neonates.”
Similarly, Rumack et al. acknowledged in their authoritative reference book that RI is a weak index to assess cerebral blood flow and mean blood flow velocity is more accurate index, which should be considered for further study.
On the other hand, the person performing the ultrasound (radiologist or radiographer) must be the same and experienced. In addition, the protocol of CDU is important that should be applied such as the same sample volume angle and segment of MCA to assess.
Finally, it seems that a single CDU index may not be a good predictor of clinical outcome for all patients with various physical conditions, and a prospective large sample size stratified study is needed.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Venkatesh I. A Study of reversal of diastolic blood flow in the middle cerebral artery using Doppler ultrasound in the prognostication in sick neonates. J Clin Neonatol 2020;9:52-6. [Full text]
Vollgraff Heidweiller-Schreurs CA, De Boer MA, Heymans MW, Schoonmade LJ, Bossuyt PMM, Mol BWJ, et al
. Prognostic accuracy of cerebroplacental ratio and middle cerebral artery Doppler for adverse perinatal outcome: Systematic review and meta-analysis. Ultrasound Obstet Gynecol 2018;51:313-22.
Levine CM. Diagnostic Ultrasound. Philadelphia: Elsevier; 2018. p. 1573-89.
Piazze JJ. Association between maternal-fetal Doppler velocimetry and fetal lung maturity. J Perinatal Med 2003;31:484-8.
Krishnamurthy MB, Pharande P, Whiteley G, Hodges RJ, Malhotra A. Postnatal middle cerebral artery Dopplers in growth-restricted neonates. Eur J Pediatr 2020;179:571-7.