Cruz-Martinez Rogelio, Figueras Francesc, Oros Daniel, Padilla Nelly, Meler Eva, Hernandez-Andrade Edgar, Gratacos Eduard
Department of Maternal-Fetal Medicine, Hospital Clinic-University of Barcelona, Barcelona, Spain.
Am J Obstet Gynecol. 2009 Nov;201(5):474.e1-7. doi: 10.1016/j.ajog.2009.05.028. Epub 2009 Jul 24.
The purpose of this study was to evaluate changes in cerebral blood perfusion and middle cerebral artery (MCA) Doppler in full-term small-for-gestational-age fetuses (SGA) and to explore their association with neonatal neurobehavioral performance.
Frontal brain perfusion that was measured by fractional moving blood volume (FMBV) and MCA Doppler pulsatility index were assessed in 60 SGA fetuses with normal umbilical artery Doppler results that were matched with adequate-for-gestational-age fetuses. Neonates were evaluated with the Neonatal-Behavioral-Assessment-Scale (NBAS).
The proportion of SGA fetuses with increased FMBV (35% vs 5%; P < .001) and decreased MCA Doppler pulsatility index (15% vs 1.7%; P < .01) was significantly higher. SGA fetuses showed poorer NBAS scores in all areas. Increased FMBV identified SGA fetuses with the highest risks of abnormal NBAS in social-interactive (odds ratio, 7.8), attention (odds ratio, 22.8), and state-organization (odds ratio, 25.0). Abnormal MCA Doppler identified SGA with abnormal scores in motor area (odds ratio, 10.7).
Increased brain blood perfusion discriminates SGA fetuses that are at risk for abnormal neurobehavior.
本研究旨在评估足月小于胎龄儿（SGA）的脑血流灌注变化及大脑中动脉（MCA）多普勒情况，并探讨其与新生儿神经行为表现的关联。
对60例脐动脉多普勒结果正常的SGA胎儿及与之匹配的适于胎龄儿，采用分数移动血容量（FMBV）测量额叶脑灌注及MCA多普勒搏动指数。新生儿采用新生儿行为评估量表（NBAS）进行评估。
FMBV增加的SGA胎儿比例（35%对5%；P<.001）及MCA多普勒搏动指数降低的SGA胎儿比例（15%对1.7%；P<.01）显著更高。SGA胎儿在所有领域的NBAS评分均较差。FMBV增加可识别出在社交互动（优势比，7.8）、注意力（优势比，22.8）和状态组织（优势比，25.0）方面NBAS异常风险最高的SGA胎儿。MCA多普勒异常可识别出运动领域评分异常的SGA胎儿（优势比，10.7）。
脑血流灌注增加可鉴别有神经行为异常风险的SGA胎儿。
