Pediatric Research Centre, University of Tampere, Tampere, Finland.
J Perinatol. 2012 Aug;32(8):631-8. doi: 10.1038/jp.2011.151. Epub 2011 Oct 20.
To establish the association of cardiotocography (CTG) and other obstetric parameters with pulsed Doppler findings in cerebral arteries during the first day of life, and to compare the cerebral artery Doppler with other determinants of asphyxia in predicting 1-year neurological outcome in asphyxiated full-term infants.
Cerebral blood flow velocity (CBFV) were measured from the anterior cerebral (ACA) and basilar (BA) arteries in 30 asphyxiated and 30 healthy-term infants using pulsed Doppler ultrasonography at approximately 24 h of age. CTG, cord artery pH, Apgar scores, biochemical asphyxia markers and symptoms of hypoxic-ischemic encephalopathy (HIE) were compared with the Doppler findings in respect of the ability to predict the outcome, defined by death or impaired neurological performance at 1 year of age.
In all, 20% of the asphyxiated infants but none in the control group had increased peak systolic CBFVs (mean+3 s.d.) in the ACA or BA. The sensitivity of increased systolic CBFV to predict abnormal outcome in the asphyxia group was 83%, specificity 95% and the sensitivity of the combination of HIE grade from 2 to 3 and increased systolic CBFV in the ACA or BA was 100% and specificity was 95%, respectively. Pathological CTG and low cord artery pH or low Apgar scores showed low predictive power.
Grade from 2 to 3 HIE and the systolic CBFV (mean+3 s.d.) in the ACA or BA by Doppler ultrasound seemed to predict the outcome in asphyxiated infants at 1 year of age better than CTG, acid basement status, Apgar scores or asphyxia markers. If an increase of more than +3 s.d. in the systolic CBFV does not occur within the first 24 h of life, a good 1-year neurological outcome may be anticipated.
建立胎儿心电图（CTG）和其他产科参数与出生后第一天大脑动脉中脉冲多普勒发现之间的关联，并比较大脑动脉多普勒与其他窒息相关因素在预测窒息足月婴儿 1 年神经预后方面的作用。
使用脉冲多普勒超声技术，在大约出生后 24 小时，对 30 例窒息和 30 例健康足月婴儿的大脑前动脉（ACA）和基底动脉（BA）进行脑血流速度（CBFV）测量。比较 CTG、脐动脉 pH 值、阿普加评分、生化窒息标志物和缺氧缺血性脑病（HIE）症状与多普勒发现，以评估其预测结局的能力，结局定义为 1 岁时死亡或神经功能受损。
在所有窒息婴儿中，20%出现 ACA 或 BA 收缩期 CBFV 增加（均值+3 个标准差），而对照组无一例出现。在窒息组中，收缩期 CBFV 增加预测异常结局的敏感性为 83%，特异性为 95%，HIE 分级为 2-3 级和 ACA 或 BA 收缩期 CBFV 增加的组合的敏感性为 100%，特异性为 95%。病理性 CTG 和低脐动脉 pH 值或低阿普加评分的预测能力较低。
HIE 分级为 2-3 级和大脑动脉多普勒超声显示的 ACA 或 BA 收缩期 CBFV（均值+3 个标准差）似乎比 CTG、酸底状态、阿普加评分或窒息标志物更能预测窒息婴儿 1 岁时的结局。如果在出生后 24 小时内未出现收缩期 CBFV 增加超过+3 个标准差，则可能预期 1 年时的神经预后良好。
