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Postnatal middle cerebral artery Dopplers in growth-restricted neonates

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Abstract

This prospective observational study compared the middle cerebral artery (MCA) Doppler characteristics of FGR neonates (N = 20) with abnormal antenatal Dopplers, with those of appropriately grown (AGA) neonates (N = 20), in the immediate postnatal period. MCA peak systolic velocity (PSV), end-diastolic velocity (EDV), pulsatility index (PI), and resistive index (RI) were measured on day 1 and day 3. MCA PSV and EDV values were not significantly different between FGR (mean (SD) gestation: 31.4 (3.1) weeks, weight 1205 (463) grams) and AGA (31.1 (3.0) weeks; 1668 (490) grams) groups, on day 1 and day 3. Both FGR (30.85 (10.02) vs. 42.12 (9.16) cm/s, p = 0.007) and AGA groups (31.77 (9.32) vs. 42.0 (8.98) cm/s, p = 0.001) showed a significant increase in MCA PSV, but only the FGR group showed significant increase in EDV values (7.01 (4.23) vs. 11.78 (4.98), p = 0.002) from day 1 to day 3. This was associated with significant differences in RI (0.72 (0.10) vs. 0.79 (0.07), p = 0.01) and PI (1.36 (0.47) vs. 1.73 (0.4), p = 0.01) values between FGR and AGA groups on day 3.

Conclusion: Significant differences in MCA resistive and pulsatility indices were noted in the first few days of life of FGR neonates with abnormal antenatal Doppler as compared with AGA neonates. This may suggest a delayed transition or persistence of cerebral redistribution in FGR neonates.

What is Known:

• FGR infants have increased risk of neonatal morbidity and mortality, and long-term neuro-disabilities.

• Antenatal Doppler Ultrasound is the most common modality used to assess fetal growth restriction.

What is New:

• Antenatally detected abnormal cerebral Dopplers may persist during the neonatal period in growth-restricted neonates.

• Early cerebral Doppler values may be a useful marker to identify “at risk” growth-restricted neonates..

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Abbreviations

ACA:

Anterior cerebral artery

AGA:

Appropriate for gestational age

CPR:

Cerebro-placental ratio

EDV:

End-diastolic velocity

FGR:

Fetal growth restriction

GA:

Gestational age

IVH:

Intraventricular hemorrhage

MCA:

Middle cerebral artery

PI:

Pulsatility index

PSV:

Peak systolic velocity

PVL:

Periventricular leukomalacia

RI:

Resistive index

UA:

Umbilical artery

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Acknowledgments

Authors acknowledge the contributions of Claire Wilks and Jemma Rawlins, midwives at Fetal Diagnostic Unit, Monash Medical Centre in recruiting the cases and procuring antenatal data.

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Authors and Affiliations

  1. Monash Newborn, Monash Children’s Hospital, 246, Clayton Road, Melbourne, VIC, 3168, Australia

    Mohan B Krishnamurthy, Pramod Pharande & Atul Malhotra

  2. Diagnostic Imaging, Monash Health, 246, Clayton Road, Melbourne, VIC, 3168, Australia

    Gillian Whiteley

  3. Department of Obstetrics and Gynaecology, Monash University, 246, Clayton Road, Melbourne, VIC, 3168, Australia

    Ryan J Hodges

  4. Department of Paediatrics, Monash University, 246, Clayton Road, Melbourne, VIC, 3168, Australia

    Atul Malhotra

Authors
  1. Mohan B Krishnamurthy
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  2. Pramod Pharande
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  3. Gillian Whiteley
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  4. Ryan J Hodges
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  5. Atul Malhotra
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Contributions

MBK obtained consent, collected data, carried out analyses of collected data, drafted the initial manuscript, and approved the final manuscript as submitted. PP performed the Doppler scans, provided constructive comments, and edited and approved the final manuscript as submitted. GW reviewed the postnatal Doppler scans, provided constructive comments, and edited and approved the final manuscript. RH reviewed and provided constructive comments and edited and approved the final manuscript as submitted. AM formulated the research question, critically reviewed the manuscript, and edited and approved the final manuscript as submitted.

Corresponding author

Correspondence to Atul Malhotra.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by Monash Health Human Research and Ethics Committee.

Informed consent

Written informed consent was obtained from all individual participants included in the study.

Additional information

Communicated by Patrick Van Reempts

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Krishnamurthy, M.B., Pharande, P., Whiteley, G. et al. Postnatal middle cerebral artery Dopplers in growth-restricted neonates. Eur J Pediatr 179, 571–577 (2020). https://doi.org/10.1007/s00431-019-03540-3

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  • DOI: https://doi.org/10.1007/s00431-019-03540-3

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