Pal Abhinav, Stewart Dan, Ojha Kshama, Kriss Vesna, Ziegler Craig, Fischer Hannah
Department of Maternal and Child, Stormont Vail Health, Topeka, KS, USA.
Department of Pediatrics, Division of Neonatal Medicine, University of Louisville School of Medicine, Louisville, USA.
BMC Pediatr. 2025 Oct 3;25(1):766. doi: 10.1186/s12887-025-06119-0.
In extremely preterm newborns, intraventricular hemorrhage (IVH) greatly influences neurodevelopmental outcomes. Preterm newborns who later develop IVH might have altered cerebral blood flow (CBF) as measured by resistive index (RI) on Doppler ultrasound. Knowledge regarding RI in extremely premature infants remains limited.
This pilot prospective cohort study aimed to evaluate the association between early cerebral RI (within the first 36 h of life) and the occurrence of IVH in preterm infants born at < 29 weeks’ gestation.
Prospective cohort study in which cranial Doppler was performed in preterm infants < 29 weeks at < 36 h of age and between 5 and 7 days of age. CBF velocities and RI were measured. Clinical and demographic factors were also assessed. Statistical analyses included Pearson’s chi-square exact test, independent -test, Mann-Whitney exact test, and Pearson’s and Spearman’s correlations when appropriate. Multiple regression and receiver operating characteristics (ROC) analysis were used to examine the association between RI and IVH. Statistical significance was set at < 0.05.
Of the 30 enrolled infants, 27% developed an IVH. RI and peak systolic/end diastolic velocity ratio measured at < 36 h of life for the neonates with IVH were significantly higher than that for the non-IVH group (0.70(± 0.04) and 3.37(± 0.46) vs. 0.65(± 0.05) and 2.91(± 0.39); = 0.02 and 0.01, respectively). Multiple regression showed RI amongst babies with IVH was higher by 0.05 when adjusted for other clinical variables ( = 0.01). Exploratory ROC analysis yielded an area under the curve (AUC) of 0.76, suggesting moderate discriminatory ability of RI to distinguish infants who developed IVH. These differences were not statistically significant when measured at 5–7 days. RI had no significant correlation with antenatal steroid use, delayed cord clamping, or presence of hemodynamically significant patent ductus arteriosus.
Higher cerebral RI measured within the first 36 h of life was associated with IVH in this pilot study. These findings are preliminary and should be interpreted cautiously due to the small sample size and the exploratory nature of the study. Larger multicenter trials with serial measurements are needed to validate RI as a predictive marker for IVH.
The online version contains supplementary material available at 10.1186/s12887-025-06119-0.
在极早产儿中，脑室内出血（IVH）对神经发育结局有很大影响。后期发生IVH的早产儿，其脑血流（CBF）可能会通过多普勒超声的阻力指数（RI）测量发生改变。关于极早产儿RI的知识仍然有限。
这项前瞻性队列研究旨在评估早产小于29周的婴儿在出生后36小时内早期脑RI与IVH发生之间的关联。
对孕周小于29周、出生后36小时内以及出生5至7天的早产儿进行前瞻性队列研究，测量其颅脑多普勒，测定CBF速度和RI，并评估临床和人口统计学因素。统计分析包括Pearson卡方精确检验、独立样本t检验、Mann-Whitney精确检验以及在适当情况下的Pearson和Spearman相关性分析。采用多元回归和受试者工作特征（ROC）分析来检验RI与IVH之间的关联，设定统计学显著性水平为P<0.05。
在纳入的30例婴儿中，27%发生了IVH。IVH新生儿在出生后36小时内测量的RI和收缩期峰值/舒张末期速度比值显著高于非IVH组（分别为0.70（±0.04）和3.37（±0.46）对比0.65（±0.05）和2.91（±0.39）；P分别为0.02和0.01）。多元回归显示，在调整其他临床变量后，IVH婴儿的RI高0.05（P=0.01）。探索性ROC分析得出曲线下面积（AUC）为0.76，表明RI区分发生IVH婴儿的能力中等。在出生5至7天测量时，这些差异无统计学意义。RI与产前使用类固醇、延迟脐带结扎或存在血流动力学显著的动脉导管未闭无显著相关性。
在这项初步研究中，出生后36小时内测量的较高脑RI与IVH有关。由于样本量小和研究的探索性质，这些发现是初步的，应谨慎解释。需要更大规模的多中心连续测量试验来验证RI作为IVH预测标志物的作用。
在线版本包含可在10.1186/s12887-025-06119-0获取的补充材料。
