Anterior cerebral artery Doppler ultrasonography for prediction of outcome after perinatal asphyxia.

During a five-year period, 47 term neonates with a history of asphyxia were investigated on the first day of life using intracranial Doppler ultrasonography to measure the Pourcelot resistance index (RI) of anterior cerebral artery. Another 30 healthy term neonates were also studied as controls. The results showed no significant differences in the gestational age and birth body weight between these two groups. However, the RI value of the Asphyxiated Group was significantly lower than that of the Control Group (mean +/- SD: 0.61 +/- 0.09 vs 0.71 +/- 0.03, respectively). End diastolic flow velocity (mean +/- SD: 10.8 +/- 3.1 vs 8.8 +/- 1.4 cm/sec) and mean flow velocity (mean +/- SD: 18.0 +/- 4.2 vs 15.6 +/- 2.1 cm/sec) of the Asphyxiated Group were significantly higher than those of the Control Group. The asphyxiated patients were divided into three groups according to RI values. There were significant differences among Group A (RI < 0.55). Group B (0.55 < or = RI < 0.6) and Group C (RI > or = 0.6). These patients were followed up clinically for 15 to 65 months (mean: 39 months). Twenty patients in the Asphyxiated Group had neurodevelopmental delay with mild to moderate handicaps, whereas none in the Control Group had neurological sequelae in the follow-up period. This study demonstrates that, on the first day of life, a low RI value for asphyxiated neonates is associated with an adverse prognosis and may be considered as one of the earliest indicators for poor neurodevelopmental outcome.