Outcome in children with significantly abnormal cerebral blood flow detected by Doppler ultrasonography: focus on the survivors.
OBJECTIVE
The Doppler waveform patterns of loss of diastolic flow, appearance of retrograde diastolic flow, or no detectable flow in the cerebral arteries suggest significantly abnormal cerebral blood flow (CBF). A retrospective study was performed to show that significantly abnormal CBF alone, without clinical criteria, is not necessarily specific to brain death in the young pediatric population.


METHODS
Forty-seven pediatric patients, from newborn to 4 years of age, were found to have significantly abnormal CBF, including 7 patients with loss of diastolic flow, 28 with retrograde diastolic flow, and 23 with no detectable cerebral flow on serial Doppler sonographic examinations. Their clinical data and sonographic results were collected and analyzed.


RESULTS
Forty-two patients died, a few of whom had only transient improvement of cerebral flow. All of the patients with no detectable cerebral flow expired. Five patients survived with or without sequelae. Their underlying conditions that caused increased intracranial pressure were treated by medical and/or surgical intervention, and diastolic reversal of CBF corrected within 1 day in all 5.


CONCLUSIONS
Although no detectable flow is a lethal sign, pediatric patients with loss or reversal of diastolic flow may survive with prompt and effective treatment. Using Doppler ultrasound to diagnose cerebral circulatory arrest should be done with caution in pediatric patients.
Chiu
Nan-Chang
NC
Department of Pediatrics, Mackay Memorial Hospital, Mackay Junior College of Nursing, Taipei, Taiwan. ncc88@ms2.mmh.org.tw
Shen
Ein-Yiao
EY
Ho
Che-Sheng
CS
D001926:Brain Death / Q000000981:diagnostic imaging / Q000503:physiopathology; D001927:Brain Diseases / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D002675:Child, Preschool; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D018608:Ultrasonography, Doppler