The “brain-sparing” effect: Antenatal cerebral Doppler findings in relation to neurologic outcome in very preterm infants

https://doi.org/10.1016/0002-9378(93)90156-DGet rights and content

OBJECTIVE: Our purpose was to study the relationship between fetal cerebral circulation and neurologic outcome.

STUDY DESIGN: In 117 high-risk fetuses (gestational age 25 to 33 weeks) flow velocity waveforms were recorded from the umbilical and medial cerebral arteries. The ratio between umbilical and cerebral pulsatility indexes was calculated. A ratio above a predefined tolerance limit was used as an index for the “brain-sparing” effect. Neonatal neurosonography and neurologic examination were used as outcome parameters.

RESULTS: Antenatally raised ratios are associated with poor obstetric outcome (fetal death and fetal growth retardation). The incidence of intracranial hemorrhages and ischemic lesions was not different for infants with a normal or raised prenatal ratio. The incidence of neurologic abnormalities was the same for both ratio groups.

CONCLUSIONS: The “brain-sparing” effect is a mechanism to prevent fetal brain hypoxia rather than a sign of impending brain damage.

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a

From the Department of Obstetrics, University of Amsterdam, Academic Medical Centre

b

From the Department of Neonatology, University of Amsterdam, Academic Medical Centre.

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