Postnatal and postinterventional cerebral Doppler ultrasound in neonates with critical congenital heart disease

Objectives: Fluctuations in cerebral perfusion contribute to brain injury in neonates with congenital heart disease. This study aimed to describe longitudinal postnatal and perioperative cerebral blood flow using bedside cerebral Doppler ultrasound. Methods: Neonates with critical congenital heart disease requiring cardiac surgery or a catheter-based valve intervention within the first 6 weeks of life were prospectively included. Cerebral Doppler ultrasound was used to repeatedly measure anterior cerebral artery flow velocity, pulsatility index, and resistive index before and up to 3 days after intervention. Brain injury was assessed on pre- and postinterventional magnetic resonance imaging. Flow parameters and their association with cardiac anatomy, prostaglandin administration, and brain injury were analyzed using mixed effects models. Results: Forty-two patients were included, with 114 preinterventional and 124 postinterventional Doppler measurements. Before intervention, peak systolic and time-averaged maximum velocity increased significantly with each day (slope 2.5 cm/s, 95% CI, 1.4-3.3, P < .001 and 1.2 cm/s, 95% CI, 0.4-2.0, P = .003), and absent diastolic flow was detected in 69% of patients. The type of congenital heart disease and prostaglandin administration were associated with higher pulsatility index (0.72, 95% CI, 0.25-1.20, P = .003; 0.55, 95% CI, 0.06-1.04, P = .028 and .68, 95% CI, 0.06-1.30, P = .031). After intervention, all flow velocities increased significantly with each day. Preinterventional (46%) and new postinterventional brain injury (53%) were not associated with flow velocities. Conclusions: Preinterventional compromised cerebral diastolic flow is common and associated with cardiac anatomy and prostaglandin therapy. Flow velocities were not associated with brain injury.