Transcranial ultrasound Doppler parameters in cerebral vessels may predict intracerebral hemorrhage in preterm newborns

Abstract

PurposeThe purpose of this study was to assess the screening of intracerebral vessels in preterm newborns in early postnatal period by transcranial ultrasound (US) Doppler parameters; as a predictive method of identifying preterm infants at risk of intracerebral hemorrhage. Patients and MethodsThe study was conducted as a screening study for 39 preterm neonates, their gestational age (GA) ranged between 26 and 35weeks, and their birth weights (BW) ranged from 900 to 2500g. They were considered clinically at risk of intracerebral hemorrhage (ICH) due to their prematurity and low birth weight. The study was focused on transcranial US Doppler examinations of cerebral vessels on the first two days of life while still no clinical evidence of ICH was detected. The routine US examination included searching for ICH, then Doppler examination was done and included measurement of peak-systolic velocity (PSV), end diastolic velocity (EDV), mean velocity (MV) and Doppler indices; resistance index (RI) and pulsatility index (PI) in anterior cerebral artery (ACA) and middle cerebral artery (MCA). US and Doppler examinations were then repeated within 4–7days for only 34 newborns as five newborns died before the time of follow up study, we searched for newborns who developed ICH and measured all these Doppler parameters again for all the remained 34 newborns and these results were correlated with clinical assessment. ResultsAll the 34 preterm newborns showed no ICH by transcranial US at the initial examination. On the follow up US-Doppler study, 16 of them (47%) developed ICH and they are classified as hemorrhage group and 18 of them (53%) did not develop ICH and they are classified as non-hemorrhage or control group. There was no statistically significant difference (P-value of >0.05) between the two groups as regards the GA, weight, mean value of PSV and MV in both Doppler examinations, and mean value of RI and PI in the initial Doppler examination, while there was statistically significant difference (P-value of <0.05) between the two groups as regards the mean value of EDV in the initial Doppler examination. Also there was statistically highly significant difference (P-value of <0.001) between the two groups as regards mean value of EDV, RI and PI in the follow up examination. The final interpretation that both newborn weight of less than 1800g and EDV value in intracerebral vessels in the initial Doppler examination of more than 9.2cm/s were the most sensitive predictors of intracerebral hemorrhage and both GA of less than 31.8week and EDV value in the initial Doppler examination of more than 9.2cm/s were the most sensitive predictors for high grades of intracerebral hemorrhage. ConclusionOur study showed that the most sensitive Doppler parameter which can be used as a predictor marker for intracerebral hemorrhage in preterm newborns in early postnatal period was end diastolic velocity>9.2cm/s and so offers a measurable screening predictor parameter, when clinical symptoms of hemorrhage may be still silent and so preventive and therapeutic actions could be useful.