A population-based study of 518 very preterm neonates from high-risk pregnancies: prognostic value of umbilical and cerebral artery Doppler velocimetry for mortality before discharge and severe neurological morbidity.
OBJECTIVE
To evaluate in everyday practice the predictiveness of fetal umbilical artery and cerebral artery Doppler examination for mortality before discharge and for severe neurological morbidity among very preterm neonates from high-risk pregnancies.


METHODS
Data came from a population-based study (EPIPAGE) of all births before 33 weeks' gestation during 1 year in nine French regions. We examined the prognostic value of Doppler findings among the liveborn singletons delivered after pregnancies with maternal hypertension or antenatal suspicion of small-for-gestational-age status.


RESULTS
This study included 518 fetuses. Predischarge mortality for infants with abnormal umbilical artery Doppler findings was not significantly higher than for those with normal findings. Mortality for infants with abnormal cerebral artery Doppler findings was significantly higher in the bivariate analysis (crude OR: 3.5 (1.6-7.4)). After adjustment, the association between mortality and abnormal cerebral artery Doppler findings remained significant in the subgroup with an abnormal umbilical artery Doppler assessment (OR: 5.1 (1.1-23)). There was no significant association between neurological morbidity and Doppler findings.


CONCLUSIONS
The prognostic value of Doppler examinations appears lower in this study than in previous hospital series. This suggests the need for quality control and improvements in these examinations.
Thiebaugeorges
Olivier
O
Unité INSERM 149, Pavillon Baudelocque, 123 Boulevard de Port Royal, 75 014 Paris, France. othiebaugeorges@yahoo.com
Ancel
Pierre-Yves
PY
Goffinet
François
F
Bréart
Gérard
G