title: Transfontanellar duplex brain ultrasonography resistive indices as a prognostic tool in neonatal hypoxic-ischemic encephalopathy before and after treatment with therapeutic hypothermia.
abstract: OBJECTIVE
  Prior to therapeutic hypothermia (that is, cooling), transfontanellar duplex brain sonography resistive indices (RI) were studied as a bedside non-invasive measures of cerebral hemodynamics in neonates who suffered from hypoxic-ischemic encephalopathy (HIE). We compared pre- and post-cooling RI values and examined the relationships between RI values and specific long-term neurodevelopmental outcomes.
  
  
  METHODS
  Transfontanellar duplex brain sonography, including RI, were obtained for 28 neonates prior to cooling and for 20 neonates following cooling. All RI values were sampled in the anterior cerebral artery at the beginning of each ultrasound study. Neurodevelopmental assessment was conducted between ages 20-32 months with the Mullen Scale of Early Learning. The relationships between pre- and post-cooling RI and cognitive and motor outcomes were studied.
  
  
  RESULTS
  Neonates with RI values <0.60 prior to and following cooling were more likely to die or have severe neurodevelopmental disability by ages 20-32 months than those with RI>0.60. Lower RI values were associated with specific neurodevelopmental deficits in motor skill attainment.
  
  
  CONCLUSIONS
  Pre- and post-cooling transfontanellar duplex brain sonography RI values may be a useful prognostic tool, in conjunction with other clinical information, for neonates diagnosed with HIE. The results of this study suggest that further study of the prognostic value of RI values for short- and long-term outcomes is warranted.
authors.affiliation: Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA.|Neurosciences Intensive Care Nursery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: G J
authors.initials: GJ
authors.lastname: Gerner
authors.affiliation: Neurosciences Intensive Care Nursery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA.
authors.forename: V J
authors.initials: VJ
authors.lastname: Burton
authors.affiliation: Neurosciences Intensive Care Nursery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: A
authors.identifier: http://orcid.org/0000-0002-9594-3858
authors.initials: A
authors.lastname: Poretti
authors.affiliation: Neurosciences Intensive Care Nursery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: T
authors.initials: T
authors.lastname: Bosemani
authors.affiliation: Neurosciences Intensive Care Nursery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA.|Division of Perinatal-Neonatal Medicine, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: E
authors.initials: E
authors.lastname: Cristofalo
authors.affiliation: Neurosciences Intensive Care Nursery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: A
authors.initials: A
authors.lastname: Tekes
authors.affiliation: Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: D
authors.initials: D
authors.lastname: Seyfert
authors.affiliation: Neurosciences Intensive Care Nursery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Division of Perinatal-Neonatal Medicine, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: C
authors.initials: C
authors.lastname: Parkinson
authors.affiliation: Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA.
authors.forename: M
authors.initials: M
authors.lastname: Leppert
authors.affiliation: Neurosciences Intensive Care Nursery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA.|Division of Perinatal-Neonatal Medicine, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: M
authors.initials: M
authors.lastname: Allen
authors.affiliation: Neurosciences Intensive Care Nursery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: T A G M
authors.initials: TA
authors.lastname: Huisman
authors.affiliation: Neurosciences Intensive Care Nursery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Division of Perinatal-Neonatal Medicine, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: F J
authors.initials: FJ
authors.lastname: Northington
authors.affiliation: Neurosciences Intensive Care Nursery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA.|Hugo Moser Research Institute, Kennedy Krieger Institute, Baltimore, MD, USA.|Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: M V
authors.initials: MV
authors.lastname: Johnston
mesh_terms: D001921:Brain / Q000098:blood supply* / Q000000981:diagnostic imaging*; D002560:Cerebrovascular Circulation; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D020925:Hypoxia-Ischemia, Brain / Q000000981:diagnostic imaging* / Q000628:therapy*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011379:Prognosis; D018615:Ultrasonography, Doppler, Color / Q000379:methods*