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Original article
Arterial flow patterns in healthy transitioning near-term neonates
  1. Amelie Stritzke1,
  2. Prashanth Murthy1,
  3. Sharandeep Kaur2,
  4. Verena Kuret3,
  5. Zhiying Liang4,
  6. Sarah Howell4,
  7. John V Tyberg4
  1. 1 Department of Neonatology/Pediatrics, University of Calgary, Calgary, AB, Canada
  2. 2 Department of Pediatrics, McMaster University, Hamilton, ON, Canada
  3. 3 Maternal-Fetal Medicine, Department of Gyn/OB, University of Calgary, Calgary, AB, Canada
  4. 4 Libin Cardiovascular Institute of Alberta, University of Calgary, AB, Calgary, AB, Canada
  1. Correspondence to Dr Amelie Stritzke; Amelie.Stritzke{at}albertahealthservices.ca

Abstract

Objective Significant haemodynamic changes occur at delivery impacting organ blood flow distribution. We aimed to characterise Doppler indices patterns over time in three different organs (brain, gut and kidney) and test them as measures of vascular resistance.

Design Observational cohort study. Serial Doppler interrogations of the anterior cerebral, superior mesenteric and renal arteries within 2 hours, 2–6, and 24 hours of life, in combination with central haemodynamic data.

Patients Healthy, near-term (>36 weeks of gestation) neonates.

Outcome measures Pulsatility (PI) and Resistance Indices (RI) patterns and organ-specific conductances, detailed echocardiographic haemodynamic measures.

Results Twenty-one babies were studied. Doppler morphology and adaptation patterns were distinctly different between the organs (brain, gut and kidney) supporting autonomous vascular regulatory effects. The PI differentiated especially between kidney and other organ flow consistently over time. PI and RI for all three organs decreased. The variance in organ conductance did not explain the variance in 1/PI, indicating that PI is not a measure of resistance. Superior mesenteric artery had the highest velocity with 72 cm/s. Non-invasively acquired pilot serial values in a normal population are given. Patent ductus arteriosus flow remained open at discharge for 36%.

Conclusions Haemodynamic transitioning patterns assessed by serial Dopplers in healthy near-term neonates differ in brain, gut and kidney: Doppler waveform morphology differs, and PI differentiates renal Doppler morphology, compared with the other organs. While PI and RI decline for all organs, they do not measure resistance. Brain artery velocity increases, mesenteric perfusion is variable and renal Vmax decreases.

  • neonatology

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Footnotes

  • Patient consent for publication Parental/guardian consent obtained.

  • Contributors AS: Planned conception and design, conducted, analysed, interpreted and reported. PM: Helped plan and design, helped conduct and helped report. SK: Helped plan and design, recruitment and helped report. VK: Helped plan and design and helped report. LZ: Statistical support. SH: Helped analyse data and report. JT: Helped plan and design, analysis and data presentation, and report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval Research Ethics Board (REB) approval was obtained (REB16-2493).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There is no additional unpublished data from the study.

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