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Cerebral Resistance Index is less predictive in hypothermic encephalopathic newborns.
MedLine Citation:
PMID:  21517959     Owner:  NLM     Status:  Publisher    
Aim:  Neonatal hypoxic-ischaemic encephalopathy (HIE), if severe, may involve cerebral vasoparalysis. In HIE, Pourcelot's cerebral vascular resistance index (RI) below 0.55 (by Doppler ultrasound) from published literature at normothermia, predicted poor outcome with a positive predictive value (PPV) of 84%. The aim of this study was to re-assess RI as a predictor of outcome in HIE during hypothermia. Methods:  125 infants with HIE treated with hypothermia with outcome data and at least one measurement of RI at 24 hours or later were included. Poor outcome was defined as death or severe disability. Results:  PPV of low RI (<0.55) was 60% (95% CI 45%, 74%), while the NPV was 78% (95% CI: 67%, 86%). The PPV during hypothermia is significantly lower than the pooled PPV of 84% (95% CI 73%, 91%) from all published studies of RI at normothermia. NPV during hypothermia and normothermia was similar (76%, [95% CI 69%, 82%]). Conclusion:  Low RI is significantly less predictive of poor outcome during hypothermia than normothermia. The lower PPV may be because hypothermia affects cerebral vasculature or protects the brain solely at a molecular and cellular level. Infants, who would have been predicted from their RI to have poorer outcome at normothermia, have better outcome when cooled.
Maja Elstad; Andrew Whitelaw; Marianne Thoresen
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-4-21
Journal Detail:
Title:  Acta paediatrica (Oslo, Norway : 1992)     Volume:  -     ISSN:  1651-2227     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-4-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9205968     Medline TA:  Acta Paediatr     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Acta Paediatrica © 2011 Foundation Acta Paediatrica.
School of Clinical Sciences, University of Bristol, Bristol, UK Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
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