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The Ratio of Flow Velocities in the Middle Cerebral and Internal Carotid Arteries for the Prediction of Cerebral Palsy in Term Neonates

Department of Neonatology, Central Hospital, Aichi Prefectural Colony, Kasugai, Aichi, Japan (M.F.); and Department of Pediatrics, Neonatology, and Congenital Disorders, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Aichi, Japan (S.F., T.K., S.K., I.K., H.T.).

Address correspondence and reprint requests to Sumio Fukuda, MD, Department of Pediatrics, Neonatology, and Congenital Disorders, Nagoya City University, Graduate School of Medical Sciences, Kawasumi, Mizuho, Nagoya, Aichi 467-8601, Japan. E-mail: fukuda{at}med.nagoya-cu.ac.jp

Objective. This study evaluated whether the ratio of the mean flow velocities in the middle cerebral artery (MCA) and the internal carotid artery (ICA) of neonates in the first days of life can be used to identify future neurodevelopmental disabilities. Methods. We observed 127 term neonates without congenital malformations, chromosomal aberrations, intracranial hemorrhage, or early onset sepsis. The mean cerebral blood flow velocities were measured in the right and left ICAs and in the right and left MCAs with a Doppler flowmeter once from day 1 to day 3. The Vm ratio was defined as the mean velocity in the right and left MCAs/mean velocity in the right and left ICAs. Neurologic examinations were performed at 12 months of age in the outpatient follow-up clinic to detect cerebral palsy (CP), and the subjects were divided into 4 groups according to the diagnosis of hypoxic-ischemic encephalopathy (HIE) and neurologic prognosis: HIE– and normal neurologic function, HIE– and CP, HIE+ and normal neurologic function, and HIE+ and CP. Results. The Vm ratio in infants with the HIE– diagnosis and CP was significantly lower than that in infants with the HIE– diagnosis without CP (P < .05). There was no significant difference between the Vm ratios in infants with the HIE+ diagnosis without CP and infants with the HIE+ diagnosis and CP. Conclusions. The Vm ratio might be a useful index in estimating neurologic outcome at birth, especially in neonates without the diagnosis of HIE.

Key Words: cerebral circulation • cerebral palsy • internal carotid artery • middle cerebral artery • ultrasonography

Abbreviations: CP, cerebral palsy • HIE, hypoxic-ischemic encephalopathy • ICA, internal carotid artery • MCA, middle cerebral artery • PI, pulsatility index • RI, resistive index • Vm ratio, mean velocity of right and left middle cerebral arteries/mean velocity of right and left internal carotid arteries

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