engleski

The Relation Between Antenatal Doppler Flow Measurements And Neurologic Outcome Of Children At 3 To 5 Years Of Age

AIM: The purpose of the study was to examine the possible relationship between fetal circulatory patterns registered by Doppler sonography and neurologic impairment in children at 3 to 5 years of age. MATHERIALS & METHODS: A retrospective study of fetal blood flow velocity waveforms in 133 high-risk pregnancies (gestational age 27-41 weeks). The data regarding neurologic development of the surviving infants were obtained by pediatricians classifying their neurologic status to normal or abnormal. Abnormal findings were further cathegorized as major (infantile cerebral palsy, generalized convulsions, severe mental retardation), minor (mild hemiparesis or monoparesis, strabismus) or mild (mild movement difficulties or mild mental retardation). RESULTS: 119 out of 133 infants (89,5%) survived the perinatal period. 16 infants suffered from neurologic illness: 4 with major neurologic impairment and 12 with mild or minor form of disease. Analysis of variance (ANOVA) revealed that mean gestational age of healthy children was significantly higher in comparison to any of the remaining groups (p<0,001). Significantly lower values of cerebral-umbilical ratio (p<0,05) and higher values of the umbilical artery resistance indices (p<0,01) in the group of children who died in the perinatal period contributed to the overall significant difference of the variance of two mentioned Doppler parameters. However, when children who died perinatally were excluded from the analysis, multiple logistic regression model found that only two variables: gestational age at birth (p<0,01) and resistance index of fetal aorta (p<0,05), can be considered as predictive factors for the development of permanent neurologic illness. Discrimination between particular degrees of neurologic impairment could not be predicted. CONCLUSION: Prematurity is the most important (and least preventable) cause of perinatal brain damage and subsequent neurologic illness. Blood circulation in fetal aorta could be an important milestone in detection of fetuses at increased risk, perhaps irrespective of their gestational age at birth. Additional morphological and functional brain assessment, as well as standardized follow-up methods are needed, however.

Doppler; neurologic outcome

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