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  • Title: Postnatal middle cerebral artery Dopplers in growth-restricted neonates.
    Author: Krishnamurthy MB, Pharande P, Whiteley G, Hodges RJ, Malhotra A.
    Journal: Eur J Pediatr; 2020 Apr; 179(4):571-577. PubMed ID: 31836914.
    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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