Department of Neonatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
Dutch Craniofacial Centre Rotterdam, Department of Plastic and Reconstructive Surgery, Erasmus Medical Center University, Rotterdam, The Netherlands.
Pediatr Res. 2020 Mar;87(Suppl 1):50-58. doi: 10.1038/s41390-020-0777-x.
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.
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.
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.
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.
非常和极早产儿经常有与脑损伤相关的长期神经发育问题。例如，在血流动力学显著的动脉导管未闭（PDA）情况下观察到的灌注改变与未成熟大脑的损伤有关。然而，尚未系统地审查其与结果的直接关系。
进行了系统评价，以提供通过多普勒超声评估的不同脑动脉血流参数与脑损伤之间关系的概述，从而预测早产儿的长期神经发育结局。
总共纳入了 23 项研究。由于研究的异质性，无法对结果进行荟萃分析。所有关于阻力指数（RI）的纳入研究均显示出具有血流动力学显著 PDA 的受试者的明显更高值。然而，RI 值的绝对差异很小。使用多普勒参数预测脑损伤和长期神经发育结局的研究结果不一致。
没有明确的证据支持常规测定脑动脉的 RI 或其他多普勒参数，以预测早产儿的脑损伤和长期神经发育结局。然而，有证据表明，升高的 RI 可能表明存在血流动力学显著的 PDA。
