ABNORMAL ANTENATAL DOPPLER AS EARLY PREDICTOR OF MORTALITY IN VERY LOW BIRTH WEIGHT (AGA) NEONATES
Objectives: To determine outcomes of very low birth weight neonates with history of absent/reversed end-diastolic umbilical artery Doppler flow (AREDF) vs. infants with forward end-diastolic flow (FEDF)
Study design: Prospective hospital based study.
Setting: SCNU, Department of pediatrics, Kamlaraja Hospital, G.R. Medical College, Gwalior.
Subjects: The study included all consecutive intramural live born neonates, delivered between July 2013 to July 2014 with birth weight of 1000-<1500 gms. All neonates received standardized neonatal care as per our protocol.
Methods-The study was conducted at Department of Pediatrics, Kamla Raja Hospital
Gwalior.400 intramural live born VLBW neonates (diagnosed as per WHO criteria) were included in the study. Data was recorded in form of103 AREDF(absent or reversed end diastolic blood flow) very low birth weight (<1500 gm) (VLBW) infants and 117 FEDF(forward end diastolic blood flow) VLBW infants were prospectively enrolled.All the vlbw neonates were followed up till the time of discharge or death.
Outcome: Mortality and major morbidity (one or more of the following: Intraventricular hemorrhage (IVH), cerebral oedema and necrotizing enterocolitis (NEC) stage III) during hospital stay.
Results: A total of 400neonates were enrolled into the study. Of these 109 died (27.25%). At 40 weeks adjusted post-menstrual age, AREDF vs. FEDF group had a higher risk for death in the NICU (10% vs. 1%), respiratory distress syndrome (33% vs. 19%), and cystic periventricular leukomalacia (14% vs. 1%). At 12-18 months corrected age, AREDF vs. FEDF group had a trend towards increased risk for cerebral palsy (7% vs. 1%, P=0.06). After logistic regression analysis, adjusting for confounders, AREDF was independently associated only with mortality in the NICU
Conclusions: AREDF is an independent predictor of adverse outcomes in preterm infants in a developing country setting.
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