Foetal umbilical artery Doppler in small preterms: (IQ) neurocognitive outcome at 5 years of age

Abstract

Aim: To investigate whether absent or reversed end-diastolic flow in the umbilical artery (AREDF) is associated with neonatal mortality, morbidity or long-term neurocognitive outcome in extremely preterm infants exposed to preeclampsia or intrauterine growth restriction.

Methods: Prenatal Doppler data were retrospectively collected for liveborn infants with gestational age (GA) <28 weeks or birth weight (BW) <1000 g, born small for gestational age (SGA- BW <5th percentile for GA) or of mothers with preeclampsia at the four largest university hospitals in Norway during 1999-2000. Neonatal mortality and morbidities, cerebral palsy (CP) and IQ at 5 years of age were compared for infants with or without AREDF.

Results: Of 260 infants, 84 were eligible and 71 of them had sufficient Doppler data. Of these, 38 (54%) had AREDF. Of 33 infants born <28 weeks, 7 of 19 (37%) with AREDF and none of 14 without AREDF had severe cerebral haemorrhage (SCH) (p = 0.01). AREDF was not significantly associated with mortality, other NICU morbidities, CP or reduced IQ. For the 38 infants with GA ≥28 weeks, AREDF (19 of 38) was not associated with adverse outcomes.

Conclusion: Absent or reversed end-diastolic flow in the umbilical artery (AREDF) was associated with increased risk of SCH in extremely preterm infants (GA <28 weeks).

Keywords: Absent or reversed end-diastolic flow; Cognitive impairment; Extremely low birth weight; Extremely premature infant; Neonatal mortality and morbidity.