The "brain-sparing" effect: antenatal cerebral Doppler findings in relation to neurologic outcome in very preterm infants.
OBJECTIVE
Our purpose was to study the relationship between fetal cerebral circulation and neurologic outcome.


METHODS
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.
Scherjon
S A
SA
Department of Obstetrics, Academic Medical Centre, University of Amsterdam, The Netherlands.
Smolders-DeHaas
H
H
Kok
J H
JH
Zondervan
H A
HA
D001783:Blood Flow Velocity; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000196:embryology / Q000502:physiology; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging; D002560:Cerebrovascular Circulation; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D009420:Nervous System / Q000000981:diagnostic imaging*; D009424:Nervous System Physiological Phenomena; D011247:Pregnancy; D011256:Pregnancy Outcome; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging / Q000502:physiology