title: Correlation between Doppler flow patterns in growth-restricted fetuses and neonatal circulation.
abstract: OBJECTIVE
  To investigate whether prenatal Doppler parameters in growth-restricted fetuses are correlated with neonatal circulatory changes.
  
  
  METHODS
  In 43 cases of suspected fetal growth restriction (FGR), serial Doppler measurements of umbilical artery (UA) and middle cerebral artery (MCA) pulsatility index (PI) were performed. The last measurement, closest to delivery (< 1 week before birth), was used for analysis. Neonatal circulation was assessed for 2 h/day on Days 1-5, 8 and 15 by near-infrared spectroscopy (NIRS) of the cerebral, renal and splanchnic regions. We calculated fractional tissue oxygen extraction (FTOE) as: (arterial oxygen saturation - NIRS value)/arterial oxygen saturation. The following ratios were calculated: cerebroplacental ratio (CPR; MCA-PI/UA-PI), cerebrorenal ratio (CRR; cerebral/renal FTOE) and cerebrosplanchnic ratio (CSR; cerebral/splanchnic FTOE). Spearman's rank correlation coefficient (ρ) was calculated between prenatal Doppler parameters and neonatal NIRS variables. These analyses were carried out for the entire group, and separately for cases of early FGR (delivered < 34 weeks) and late FGR (≥ 34 weeks).
  
  
  RESULTS
  Fetal Doppler parameters correlated with neonatal NIRS variables on Days 1-3: UA-PI correlated with renal FTOE (Day 1: ρ = 0.454, P < 0.01) and CRR (Day 1: ρ = -0.517, P < 0.001). MCA-PI correlated with cerebral FTOE on Day 2 (ρ = 0.469, P < 0.01), approached statistical significance on Day 3 but was not correlated on Day 1. CPR correlated with CRR (Day 1: ρ = 0.474, P < 0.01). Most associations lost their statistical significance when early and late FGR subgroups were considered separately.
  
  
  CONCLUSIONS
  Low MCA-PI and low CPR, indicating brain sparing before birth, are associated with low CRR after birth, indicating relatively greater blood flow to the cerebrum than to the renal region. Based on the results of this study, it could be speculated that if brain sparing is present in the fetal circulation, it persists during the first 3 days after birth. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
authors.affiliation: Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.|Department of Fetal Medicine, Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: J C
authors.initials: JC
authors.lastname: Tanis
authors.affiliation: Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: M R
authors.initials: MR
authors.lastname: Boelen
authors.affiliation: Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: D M
authors.initials: DM
authors.lastname: Schmitz
authors.affiliation: Department of Fetal Medicine, Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Casarella
authors.affiliation: Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: M E
authors.initials: ME
authors.lastname: van der Laan
authors.affiliation: Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: A F
authors.initials: AF
authors.lastname: Bos
authors.affiliation: Department of Fetal Medicine, Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: C M
authors.initials: CM
authors.lastname: Bilardo
mesh_terms: D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005333:Fetus / Q000098:blood supply*; D006801:Humans; D007231:Infant, Newborn; D017078:Laser-Doppler Flowmetry / Q000379:methods*; D008297:Male; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000196:embryology / Q000503:physiopathology*; D011247:Pregnancy; D011446:Prospective Studies; D019265:Spectroscopy, Near-Infrared / Q000379:methods*; D016216:Ultrasonography, Prenatal / Q000379:methods; D014469:Umbilical Arteries / Q000000981:diagnostic imaging / Q000196:embryology / Q000503:physiopathology*
keywords: Doppler; FGR; NIRS; brain sparing; near-infrared spectroscopy