Table_3_Feasibility of Doppler Ultrasound for Cortical Cerebral Blood Flow Velocity Monitoring During Major Non-cardiac Surgery of Newborns.DOCX

Background and Aim: Newborns needing major surgical intervention are at risk of brain injury and impaired neurodevelopment later in life. Disturbance of cerebral perfusion might be an underlying factor. This study investigates the feasibility of serial transfontanellar ultrasound measurements of the pial arteries during neonatal surgery, and whether perioperative changes in cerebral perfusion can be observed and related to changes in the perioperative management.Methods: In this prospective, observational feasibility study, neonates with congenital diaphragmatic hernia and esophageal atresia scheduled for surgical treatment within the first 28 days of life were eligible for inclusion. We performed transfontanellar directional power Doppler and pulsed wave Doppler ultrasound during major high-risk non-cardiac neonatal surgery. Pial arteries were of interest for the measurements. Extracted Doppler ultrasound parameters were: peak systolic velocity, end diastolic velocity, the resistivity index and pulsatility index.Results: In 10 out of 14 patients it was possible to perform perioperative measurements; the others failed for logistic and technical reasons. In 6 out of 10 patients, it was feasible to perform serial intraoperative transfontanellar ultrasound measurements with directional power Doppler and pulsed wave Doppler of the same pial artery during neonatal surgery. Median peak systolic velocity was ranging between 5.7 and 7.0 cm s−1 and end diastolic velocity between 1.9 and 3.2 cm s−1. In patients with a vasoactive-inotropic score below 12 the trend of peak systolic velocity and end diastolic velocity corresponded with the mean arterial blood pressure trend.Conclusion: Perioperative transfontanellar ultrasound Doppler measurements of the pial arteries are feasible and provide new longitudinal data about perioperative cortical cerebral blood flow velocity.Trial Registration:https://www.trialregister.nl/trial/6972, identifier: NL6972.

背景与目的：需要接受重大外科手术的新生儿面临日后发生脑损伤和神经发育障碍的风险。脑灌注的紊乱可能是一个潜在因素。本研究旨在探讨在新生儿手术期间进行连续经颚超声测量脑膜动脉的可行性，以及围手术期脑灌注的变化是否可以被观察并与其围手术期管理的变化相关联。方法：在本项前瞻性、观察性可行性研究中，28天内计划接受手术治疗先天性膈疝和食管闭锁的新生儿有资格纳入研究。我们在高风险非心脏新生儿重大手术期间进行了经颚方向性功率多普勒和脉冲波多普勒超声检查。脑膜动脉是我们关注的测量对象。提取的多普勒超声参数包括：收缩期峰值速度、舒张末期速度、阻力指数和脉动指数。结果：在14名患者中有10名可以进行围手术期测量；其余患者由于逻辑和技术原因未能成功。在10名患者中有6名，在新生儿手术期间可行连续的经颚超声测量同一脑膜动脉的方向性功率多普勒和脉冲波多普勒。收缩期峰值速度的中位数为5.7至7.0 cm s−1，舒张末期速度的中位数为1.9至3.2 cm s−1。在血管活性-正性肌力评分低于12分的患者中，收缩期峰值速度和舒张末期速度的趋势与平均动脉血压的趋势相一致。结论：围手术期经颚超声多普勒测量脑膜动脉是可行的，并提供了关于围手术期皮质脑血流速度的新纵向数据。临床试验注册：https://www.trialregister.nl/trial/6972，标识符：NL6972。