Table_2_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：对于需要接受重大外科手术的新生儿而言，其日后可能出现脑损伤和神经发育障碍的风险。脑部灌注的紊乱可能是一个潜在的病理因素。本研究旨在探讨在新生儿手术期间进行连续经额窦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到，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，出生后28天内接受手术治疗的原发性膈疝和食管闭锁新生儿符合纳入标准。我们在高风险的非心脏新生儿重大手术期间进行了经额窦方向性功率多普勒和脉冲波多普勒超声检查。脑膜动脉是本研究的测量对象。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；其余因逻辑和技术原因而未能进行。在10名患者中，有6名在新生儿手术期间能够进行连续的经额窦超声测量，并使用方向性功率多普勒和脉冲波多普勒对同一脑膜动脉进行测量。收缩期峰值速度的中位数介于5.7至7.0 cm s−1之间，舒张末期速度介于1.9至3.2 cm s−1之间。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变化趋势与平均动脉血压的变化趋势相一致。结论：围手术期经额窦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层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。