Diagnostic and predictive value of Doppler ultrasound for evaluation of the brain circulation in preterm infants: a systematic review

Fleur A Camfferman, Robbin de Goederen, Paul Govaert, Jeroen Dudink, Frank van Bel, Adelina Pellicer, Filip Cools, eurUS.brain group, Thais Agut, Ana Alarcon, Roberta Arena, Marco Bartocci, Mayka Bravo, Fernando Cabañas, Nuria Carreras, Olivier Claris, Jeroen Dudink, Monica Fumagalli, Paul Govaert, Sandra Horsch, Alessandro Parodi, Adelina Pellicer, Luca Ramenghi, Charles C Roehr, Sylke Steggerda, Eva Valverde, Fleur A Camfferman, Robbin de Goederen, Paul Govaert, Jeroen Dudink, Frank van Bel, Adelina Pellicer, Filip Cools, eurUS.brain group, Thais Agut, Ana Alarcon, Roberta Arena, Marco Bartocci, Mayka Bravo, Fernando Cabañas, Nuria Carreras, Olivier Claris, Jeroen Dudink, Monica Fumagalli, Paul Govaert, Sandra Horsch, Alessandro Parodi, Adelina Pellicer, Luca Ramenghi, Charles C Roehr, Sylke Steggerda, Eva Valverde

Abstract

Introduction: Very and extremely preterm infants frequently have brain injury-related long-term neurodevelopmental problems. Altered perfusion, for example, seen in the context of a hemodynamically significant patent ductus arteriosus (PDA), has been linked to injury of the immature brain. However, a direct relation with outcome has not been reviewed systematically.

Methods: A systematic review was conducted to provide an overview of the value of different cerebral arterial blood flow parameters assessed by Doppler ultrasound, in relation to brain injury, to predict long-term neurodevelopmental outcome in preterm infants.

Results: In total, 23 studies were included. Because of heterogeneity of studies, a meta-analysis of results was not possible. All included studies on resistance index (RI) showed significantly higher values in subjects with a hemodynamically significant PDA. However, absolute differences in RI values were small. Studies using Doppler parameters to predict brain injury and long-term neurodevelopmental outcome were inconsistent.

Discussion: There is no clear evidence to support the routine determination of RI or other Doppler parameters in the cerebral arteries to predict brain injury and long-term neurodevelopmental outcome in the preterm infant. However, there is evidence that elevated RI can point to the presence of a hemodynamically significant PDA.

Conflict of interest statement

A.P. has received funding from Chiesi. The authors have declared no competing interests.

Figures

Fig. 1. GMH/IVH: Doppler systematic review: arterial…
Fig. 1. GMH/IVH: Doppler systematic review: arterial flow indices.
AUVC area under the velocity curve, FVI flow velocity integral, Vmn mean velocity = MV in the text.
Fig. 2
Fig. 2
GMH/IVH: Doppler systematic review.
Fig. 3
Fig. 3
GMH/IVH: Doppler systematic review: bias results.

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