Transcranial Ultrasonography Doppler in Detecting Clinical Outcome of Term Neonates with Perinatal Asphyxia: A Longitudinal Study

Introducton: Perinatal asphyxia is one of the most important causes of mortality and morbidity in full-term neonates, where due to the hypoxic insult, mortality and various morbidities happens. So, it is important to predict both the outcomes to aid in patient management, as well as to counsel the caregivers regarding the outcome of the patient, especially the neurological outcome. Aim: To determine the usefulness of abnormal Resistive Index (RI) values on transcranial USG doppler and its association with clinical outcomes in term neonates with perinatal asphyxia. Materials and Methods: This prospective longitudinal study was conducted in the extramural Neonatal Intensive Care Unit (NICU) and Rukmani Chainani NICU of Sir Sayaji General (SSG) Hospital, Vadodara, Gujarat, India, from June 2020 to November 2021. Study was conducted among a cohort of 174 term newborns with perinatal asphyxia admitted in both intramural and extramural NICU of SSG Hospital Vadodara. Neurodevelopmental assessment was done by Amiel-tison scoring system, done at birth, at the time of discharge, at three and six months of age with simultaneous RI value monitoring by a trained radiology resident. The clinical association was done in terms of mortality at birth, morbidities encountered during the NICU stay and neurological outcome at six months of age. Development assessment was done by history taking and clinical examination, patients with delay in two or more domains were classified as global developmental delay, patients with delay in less than two domains were classified as mild developmental delay. Continuable variables were analysed using one-way Analysis of Variance (ANOVA). Categorical data were analysed with Pearson’s Chi-square test. Significance was defined by p-values less than 0.05 using a two-tailed test. Results: Out of 174 newborns enrolled, 97 patients had normal RI values at birth, and 77 patients had abnormal RI values. Forty-eight patients expired after birth, with 27% mortality, and among which 43 patients had abnormal RI values at birth, which was statistically significant (p-value <0.0001). The majority of the newborns with abnormal RI required invasive mechanical ventilation (n=62) and had persistent pulmonary hypertension of newborn (n=40), ventricular dysfunction (n=33), feed intolerance (n=17), acute kidney injury (n=19) and sepsis (n=27). Conclusion: Transcranial Ultrasonography (USG) doppler in the calculation of RI at birth is a useful non invasive point of care method to determine immediate short-term outcomes in the form of mortality and short-term morbidities encountered during NICU stay.