Newborns with a Congenital Heart Defect and Diastolic Steal Have an Altered Cerebral Arterial Doppler Profile
Issued Date
2023-01-01
Resource Type
ISSN
00223476
eISSN
10976833
Scopus ID
2-s2.0-85150837427
Pubmed ID
36868306
Journal Title
Journal of Pediatrics
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Pediatrics (2023)
Suggested Citation
Mir M., Moore S.S., Wutthigate P., Simoneau J., Villegas Martinez D., Shemie S.D., Brossard-Racine M., Dancea A., Bertolizio G., Altit G. Newborns with a Congenital Heart Defect and Diastolic Steal Have an Altered Cerebral Arterial Doppler Profile. Journal of Pediatrics (2023). doi:10.1016/j.jpeds.2023.02.015 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/82543
Title
Newborns with a Congenital Heart Defect and Diastolic Steal Have an Altered Cerebral Arterial Doppler Profile
Other Contributor(s)
Abstract
Objectives: To compare trends in the anterior cerebral artery (ACA) Doppler markers of vascular flow for neonates with a congenital heart defect (CHD) with and without diastolic systemic steal during the first 7 days of life. Methods: Prospective study recruiting newborns (≥35 weeks of gestation) with a CHD. Doppler ultrasound and echocardiography were performed daily from day 1 to 7. The cohort was divided into the presence/absence of holo-diastolic retrograde flow in the postductal aorta (“retrograde”) on the last-available echocardiogram. Data extractors were masked to retrograde status. Mixed effect models (random slope/intercept) were constructed using RStudio. Results: We enrolled 38 neonates with CHD. Retrograde aortic flow was present on the last echocardiogram in 23 (61%). Peak systolic velocity and mean velocity increased significantly over time, independent of retrograde status. However, having a “retrograde” flow status conferred a significant decrease over time of their ACA–end-diastolic velocity (β = –5.75 cm/s, 95% CI −8.38 to −3.12, P < .001, when compared with the nonretrograde group), and a significant increase in the ACA resistive (β = 0.16, 95% CI 0.10-0.22, P < .001) and pulsatility (β = 0.49, 95% CI 0.28-0.69, P < .001) indexes. No subject presented retrograde diastolic flow in the ACA. Conclusions: In neonates with CHD in the first week of life, infants with echocardiographic signs of systemic diastolic steal within the pulmonary circulation have Doppler signs of cerebrovascular steal in the ACA.