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The “brain-sparing” effect: Antenatal cerebral Doppler findings in relation to neurologic outcome in very preterm infants

1993; Elsevier BV; Volume: 169; Issue: 1 Linguagem: Inglês

10.1016/0002-9378(93)90156-d

1097-6868

Sicco A. Scherjon, Hetty Smolders-DeHaas, Joke H. Kok, H.A. Zondervan,

Congenital Heart Disease Studies

OBJECTIVE: Our purpose was to study the relationship between fetal cerebral circulation and neurologic outcome. STUDY DESIGN: In 117 high-risk fetuses (gestational age 25 to 33 weeks) flow velocity waveforms were recorded from the umbilical and medial cerebral arteries. The ratio between umbilical and cerebral pulsatility indexes was calculated. A ratio above a predefined tolerance limit was used as an index for the "brain-sparing" effect. Neonatal neurosonography and neurologic examination were used as outcome parameters. RESULTS: Antenatally raised ratios are associated with poor obstetric outcome (fetal death and fetal growth retardation). The incidence of intracranial hemorrhages and ischemic lesions was not different for infants with a normal or raised prenatal ratio. The incidence of neurologic abnormalities was the same for both ratio groups. CONCLUSIONS: The "brain-sparing" effect is a mechanism to prevent fetal brain hypoxia rather than a sign of impending brain damage. OBJECTIVE: Our purpose was to study the relationship between fetal cerebral circulation and neurologic outcome. STUDY DESIGN: In 117 high-risk fetuses (gestational age 25 to 33 weeks) flow velocity waveforms were recorded from the umbilical and medial cerebral arteries. The ratio between umbilical and cerebral pulsatility indexes was calculated. A ratio above a predefined tolerance limit was used as an index for the "brain-sparing" effect. Neonatal neurosonography and neurologic examination were used as outcome parameters. RESULTS: Antenatally raised ratios are associated with poor obstetric outcome (fetal death and fetal growth retardation). The incidence of intracranial hemorrhages and ischemic lesions was not different for infants with a normal or raised prenatal ratio. The incidence of neurologic abnormalities was the same for both ratio groups. CONCLUSIONS: The "brain-sparing" effect is a mechanism to prevent fetal brain hypoxia rather than a sign of impending brain damage.