Author: Luo, Qiu
Title: Comparison of cerebral blood flow velocity and cerebrovascular resistance estimation using cranial ultrasound imaging for early prediction of outcomes in preterm neonates
Advisors: Pin, Tamis (RS)
Degree: DHSc
Year: 2020
Subject: Premature infants
Pediatric diagnostic imaging
Hong Kong Polytechnic University -- Dissertations
Department: Faculty of Health and Social Sciences
Pages: 76, 27 pages : color illustrations
Language: English
Abstract: Preterm birth is defined as birth before 37th week of gestation. Although the survival rate of preterm (PT) infants has increased, prediction of the developmental outcomes of the survivors remains challenging. The present study aimed to examine a serial cranial blood hemodynamics of bilateral middle cerebral arteries (MCAs) based on the cranial ultrasound (cUS) findings in PT neonates in the first three days post birth. The secondary objective of this study was to understand whether these early cranial blood hemodynamic parameters could be a useful marker of brain injury and if they could predict the outcomes of the PT infants at 37 weeks of gestation, i.e. defined as equivalent to term age. Other clinical variables were explored if they could affect the outcomes of the PT infants at 37 weeks of gestation. One hundred and fourteen PT neonates were recruited. Clinical characteristics including gestational age, birth weight, risk factors of prematurity and maternal age, and measurements of the serial cUS on bilateral MCAs in the first 72 hours post birth were collected. All neonates were assessed using the Neonatal Behavioral Neurological Assessment (NBNA) at 37 weeks of gestation. Eight neonates died before the NBNA and hence, the results were based on the 106 surviving infants. The mean blood flow velocity (MBFV) in the right MCA was significantly different across the first three days post birth in the VP and MLP groups with the lowest velocity at 12-24 hours and the fastest at 60-72 hours post birth. The MBFV in right MCA in general were significantly higher than the left MCA in very PT and moderate to late PT infants. Multivariate logistic regression model has shown that based on the MBFV of the right MCA at 60-72 hours post birth for the very PT infants, the cut-off point of the MBFV was 21.95 cm/s with sensitivity of 56.8% and specificity of 18.8%. for the moderate to late PT infants, the cut-off point of the MBFV of the right MCA at the 60-72 hours was with sensitivity of 70.3% and specificity of 10%. The implications of monitoring cerebral blood flow velocity in the first 72 hours post birth in understanding the developmental outcomes of the PT infants are discussed. A more robust model including both clinical variables and hemodynamic parameters using cUS is required to predict the developmental outcomes of PT infants.
Rights: All rights reserved
Access: restricted access

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