Division of Critical Care Medicine, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada; Division of Pediatrics, Universitat Autonoma de Barcelona, Barcelona, Spain; Institute for Research and Innovation Parc Tauli (I3PT), Barcelona, Spain; Department of Pediatrics, McGill University, Montreal, Quebec, Canada.
Division of Neonatology, Dana Dwek Children's Hospital, Tel Aviv Medical Center, Tel-Aviv, Israel.
J Pediatr. 2023 Jun;257:113369. doi: 10.1016/j.jpeds.2023.02.015. Epub 2023 Mar 2.
To compare trends in the anterior cerebral artery (ACA) Doppler markers of vascular flow for neonates with a congenital heart defect (CHD) with and without diastolic systemic steal during the first 7 days of life.
Prospective study recruiting newborns (≥35 weeks of gestation) with a CHD. Doppler ultrasound and echocardiography were performed daily from day 1 to 7. The cohort was divided into the presence/absence of holo-diastolic retrograde flow in the postductal aorta ("retrograde") on the last-available echocardiogram. Data extractors were masked to retrograde status. Mixed effect models (random slope/intercept) were constructed using RStudio.
We enrolled 38 neonates with CHD. Retrograde aortic flow was present on the last echocardiogram in 23 (61%). Peak systolic velocity and mean velocity increased significantly over time, independent of retrograde status. However, having a "retrograde" flow status conferred a significant decrease over time of their ACA-end-diastolic velocity (β = -5.75 cm/s, 95% CI -8.38 to -3.12, P < .001, when compared with the nonretrograde group), and a significant increase in the ACA resistive (β = 0.16, 95% CI 0.10-0.22, P < .001) and pulsatility (β = 0.49, 95% CI 0.28-0.69, P < .001) indexes. No subject presented retrograde diastolic flow in the ACA.
In neonates with CHD in the first week of life, infants with echocardiographic signs of systemic diastolic steal within the pulmonary circulation have Doppler signs of cerebrovascular steal in the ACA.
比较患有先天性心脏病（CHD）的新生儿在生命的前 7 天中，前脑动脉（ACA）血流的多普勒标志物的趋势，这些新生儿中有和没有舒张期系统性窃血。
前瞻性研究招募了≥35 周胎龄的患有 CHD 的新生儿。从第 1 天到第 7 天，每天进行多普勒超声和超声心动图检查。该队列根据最后一次可获得的超声心动图上的动脉导管后主动脉全舒张期逆行血流（“逆行”）的存在/缺失情况进行分组。数据提取器对逆行状态进行了屏蔽。使用 RStudio 构建了混合效应模型（随机斜率/截距）。
我们纳入了 38 名患有 CHD 的新生儿。23 名（61%）新生儿的最后一次超声心动图上存在逆行主动脉血流。峰值收缩速度和平均速度随时间显著增加，与逆行状态无关。然而，“逆行”血流状态与 ACA 舒张末期速度随时间的显著下降相关（β=-5.75cm/s，95%CI-8.38 至-3.12，P<.001，与非逆行组相比），并且 ACA 阻力（β=0.16，95%CI0.10-0.22，P<.001）和搏动指数（β=0.49，95%CI0.28-0.69，P<.001）显著增加。没有受试者出现 ACA 舒张期逆行血流。
在生命的前一周患有 CHD 的新生儿中，在肺循环中出现超声心动图系统性舒张期窃血迹象的婴儿，其 ACA 存在脑血管窃血的多普勒征象。
