title: New Doppler index for prediction of perinatal brain damage in growth-restricted and hypoxic fetuses.
abstract: OBJECTIVE
  To evaluate the new vascular score, hypoxia index (HI), in the prediction of sonographically detected structural brain lesions in neonates within the first week after delivery of growth-restricted fetuses.
  
  
  METHODS
  This prospective study included 29 growth-restricted fetuses delivered between 31 and 40 gestational weeks. Doppler umbilical artery (UA) and middle cerebral artery (MCA) resistance indices (RI) were recorded at 48-h intervals for at least 2 weeks before delivery. The cerebroumbilical ratio (C/U ratio = MCA-RI/UA-RI) and the HI (the sum of the daily reductions in C/U ratio, i.e. percentage below the cut-off value of 1, over the period of observation) were calculated. After delivery, neonatal outcome was evaluated according to obstetric parameters and ultrasound examinations of the brain. Doppler indices, C/U ratio and HI, as well as neonatal clinical and biochemical parameters, were tested as potential predictors of brain lesions using the C4.5 data-mining algorithm.
  
  
  RESULTS
  Neonatal brain lesions were detected in 13 growth-restricted fetuses. Of all the parameters tested by the C4.5 data-mining algorithm, only HI was identified as a predictor of neonatal brain lesions. HI also showed better correlation with neonatal biochemical parameters, such as umbilical venous partial pressure of oxygen and umbilical venous pH, compared with the C/U ratio.
  
  
  CONCLUSIONS
  HI, which takes into account cumulative oxygen deficit, could significantly improve the prediction of a poor neurological outcome in pregnancies complicated by growth restriction and hypoxia.
authors.affiliation: Department of Physiology, Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia.
authors.forename: D
authors.initials: D
authors.lastname: Jugović
authors.forename: J
authors.initials: J
authors.lastname: Tumbri
authors.forename: M
authors.initials: M
authors.lastname: Medić
authors.forename: M Kusan
authors.initials: MK
authors.lastname: Jukić
authors.forename: A
authors.initials: A
authors.lastname: Kurjak
authors.forename: P
authors.initials: P
authors.lastname: Arbeille
authors.forename: A
authors.initials: A
authors.lastname: Salihagić-Kadić
mesh_terms: D001724:Birth Weight; D001927:Brain Diseases / Q000000981:diagnostic imaging* / Q000196:embryology / Q000209:etiology / Q000503:physiopathology; D002245:Carbon Dioxide / Q000097:blood; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005311:Fetal Hypoxia / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D011247:Pregnancy; D011256:Pregnancy Outcome; D011379:Prognosis; D011446:Prospective Studies; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal / Q000379:methods; D014469:Umbilical Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology; D014471:Umbilical Veins / Q000000981:diagnostic imaging / Q000503:physiopathology; D014655:Vascular Resistance
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen