Does abnormal Doppler on cranial ultrasound predict disability in infants with hypoxic‐ischaemic encephalopathy? A systematic review. (7th April 2022)

• Record Type: Journal Article
• Authors: Rath, Chandra; Rao, Shripada; Suryawanshi, Pradeep; Desai, Saumil; Chetan, Chinmay; Patil, Karamchand; Patole, Sanjay
• Is Part Of: Developmental medicine & child neurology. Volume 64:Number 10(2022)
• Page Start: 1202
• Page End: 1213
• Publication Date: 2022-04-07
• Subjects: Child development -- Periodicals; Pediatric neurology -- Periodicals; 616.8
• DOI: 10.1111/dmcn.15236
• Languages: English
• ISSNs: 0012-1622

Abstract

Abstract: Aim: To evaluate whether abnormal resistive index or cerebral blood flow velocity (CBFV) on cranial ultrasound predicts disability (≥1 year) in infants with hypoxic‐ischaemic encephalopathy (HIE). Method: This was a systematic review and meta‐analysis of studies comparing developmental outcomes of infants with HIE with normal versus abnormal resistive index or CBFV. Results: Twenty‐six studies were included (pre‐therapeutic hypothermia era, 20; therapeutic hypothermia era, six). Data from 15 studies (pre‐therapeutic hypothermia, 10; therapeutic hypothermia, five) were available for meta‐analysis. Pooled sensitivity and specificity, summary area under the receiver operating characteristic curve, and diagnostic odds ratio of resistive index or CBFV for predicting 'death or severe disability' were as follows. Pre‐therapeutic hypothermia era: 0.83 (95% confidence interval [CI] 0.45–0.97) and 0.92 (95% CI 0.74–0.98), 0.94 (95% CI 0.92–0.96), 54 (95% CI 7–391). Therapeutic hypothermia era (measurements before therapeutic hypothermia): 0.62 (95% CI 0.41–0.80) and 0.96 (95% CI 0.88–0.99), 0.93 (95% CI 0.89–0.94), 23 (95% CI 6–91). Therapeutic hypothermia era (measurements during/after therapeutic hypothermia): 0.51 (95% CI 0.24–0.78) and 0.83 (95% CI 0.73–0.90), 0.81 (95% CI 0.78–0.85), 5 (95% CI 2–13). Overall Grading of Recommendations Assessment, Development and Evaluation (GRADE) rating of evidence was 'low' or 'very low'. Interpretation: Low‐level evidence suggests that abnormal resistive index or CBFV can predict death or disability with high sensitivity and specificity in infants with HIE who are not cooled. The specificity of these tests was high when performed before starting cooling in infants who received therapeutic hypothermia. What this paper adds: Cerebral doppler ultrasound may be useful in predicting death or disability in infants with hypoxic‐ischaemic encephalopathy who are not cooled. Cerebral doppler ultrasound may also be useful in infants who are cooled, if done before starting cooling. Cerebral doppler ultrasound may not be useful when performed during or after completing cooling. What this paper adds: Cerebral doppler ultrasound may be useful in predicting death or disability in infants with hypoxic‐ischaemic encephalopathy who are not cooled. Cerebral doppler ultrasound may also be useful in infants who are cooled, if done before starting cooling. Cerebral doppler ultrasound may not be useful when performed during or after completing cooling. Abnormal doppler on cranial ultrasound in neonates with hypoxic ischemic encephalopathy can predict disability. This article's abstract has been translated into Portuguese. Follow the links from the abstract to view the translations. O Doppler anormal na ultrassonografia craniana prediz incapacidade em bebês com encefalopatia hipóxico‐isquêmica? Uma revisão sistemática: Objetivo: Avaliar se o índice de resistência anormal ou a velocidade do fluxo sanguíneo cerebral (VFSC) na ultrassonografia craniana prediz incapacidade (≥1 ano) em bebês com encefalopatia hipóxico‐isquêmica (EHI). Método: Esta foi uma revisão sistemática e meta‐análise de estudos comparando os resultados do desenvolvimento de bebês com EHI com índice de resistência normal versus anormal ou VFSC. Resultados: Vinte e seis estudos foram incluídos (hipotermia pré‐terapêutica, 20; hipotermia terapêutica, 6). Dados de 15 estudos (hipotermia pré‐terapêutica, 10; hipotermia terapêutica, 5) estavam disponíveis para meta‐análise. Sensibilidade e especificidade agrupadas, área de resumo sob a curva característica de operação do receptor e razão de chances de diagnóstico do índice resistivo ou VFSC para prever "morte ou incapacidade grave" foram os seguintes. (1) Hipotermia pré‐terapêutica: 0, 83 (intervalo de confiança de 95% [IC] 0, 45–0, 97) e 0, 92 (IC 95% 0, 74–0, 98), 0, 94 (IC 95% 0, 92–0, 96), 54 (IC 95% 7‐391). (2) Hipotermia terapêutica (medições antes da hipotermia terapêutica): 0, 62 (IC 95% 0, 41–0, 80) e 0, 96 (IC 95% 0, 88–0, 99), 0, 93 (IC 95% 0, 89–0, 94), 23 (IC 95% 6–91). (3) Hipotermia terapêutica (medidas durante/após a hipotermia terapêutica): 0, 51 (IC 95% 0, 24–0, 78) e 0, 83 (IC 95% 0, 73–0, 90), 0, 81 (IC 95% 0, 78–0, 85), 5 (IC 95% 2 ‐13). A classificação geral das evidências de Avaliação, Desenvolvimento e Avaliação de Recomendações (GRADE) foi 'baixa' ou 'muito baixa'. Interpretação: Evidências de baixo nível sugerem que anormalidades índice resistivo ou VFSC pode prever morte ou incapacidade com alta sensibilidade e especificidade em bebês com EHI que não são resfriados. A especificidade desses testes foi alta quando realizados antes do início do resfriamento em bebês que receberam hipotermia terapêutica