Resistive Index in Late-Onset Neonatal Sepsis

Background and Objectives: Hemodynamics in neonatal sepsis is complex and poorly understood. Several studies have reported conflicting findings on cerebral blood flow (CBF) in sepsis from severely increased flow to severely decreased flow. The objective of our study was to study CBF by measuring the resistive index (RI) of the anterior cerebral artery in late-onset neonatal sepsis (LONS). Methods: All newborn infants admitted in our neonatal intensive care unit with suspected LONS during the period from January 2017 to December 2017 underwent point-of-care transcranial Doppler ultrasonography to measure the RI of the anterior cerebral artery within 24 h of clinical presentation before starting inotropes if at all required. Infants with congenital heart disease, perinatal asphyxia, major congenital malformations, and genetic syndromes were excluded. Neonates with positive culture were included in the final analysis. Results: Of 89 suspected LONS, 33 were culture positive and were analyzed. The mean admission weight was 2.33 ± 0.76 kg. The mean gestational age was 33.5 ± 3.4 wk. Most common organism isolated was Klebsiella pneumoniae (82%). The RI was high in 54.5% (17 of 33) and normal in 45.5% (15 of 33) cases. Conclusions: LONS is a unique and complex hemodynamic state and we found it associated with the high RI indicating decreased CBF. A larger study may help in more understanding of this unique hemodynamic association.

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Reversal of End Diastolic Flow in Anterior Cerebral Artery in Late-Onset Neonatal Sepsis

Journal of Neonatology ◽

10.1177/0973217918795009 ◽

2018 ◽

Vol 32 (2-3) ◽

pp. 71-73

Author(s):

Yengkhom Rameshwor Singh ◽

Pradeep Suryawanshi

Keyword(s):

Blood Flow ◽

Neonatal Sepsis ◽

Anterior Cerebral Artery ◽

Late Onset ◽

Resistive Index ◽

Cerebral Hemodynamics ◽

Myocardial Depression ◽

Volume Depletion ◽

Systemic Blood Flow ◽

Diastolic Flow

Hemodynamics in neonatal sepsis is complex and poorly understood. Circulatory abnormalities are variable from vasodilatation with increased systemic blood flow to vasoconstriction with decreased blood flow, volume depletion or myocardial depression. Cerebral hemodynamics changes in neonatal sepsis. Most studies on cerebral hemodynamics in neonatal sepsis till now have been conducted on early-onset neonatal sepsis, and most of them have shown increased cerebral blood flow with a decreased resistive index (RI) in sepsis. Only a few studies have documented decreased cerebral flow in neonatal sepsis. Here we report a case of late-onset neonatal sepsis with the reversal of end diastolic flow, leading to increased RI associated with the death of the infant.

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Feasibility of Ultrafast Doppler technique for cranial ultrasound in neonates

Medical Ultrasonography ◽

10.11152/mu-1901 ◽

2019 ◽

Vol 21 (3) ◽

pp. 288

Author(s):

Hyun Gi Kim ◽

Jang Hoon Lee

Keyword(s):

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Posterior Cerebral Artery ◽

Peak Systolic Velocity ◽

Resistive Index ◽

Quantitative Information ◽

Cranial Ultrasound ◽

Doppler Us ◽

Diastolic Velocity ◽

Cranial Arteries

Aims: The aim of this study was to compare the performances of Ultrafast Doppler ultrasound (US) with classic Doppler US, for cranial ultrasound in neonates.Materials and methods: We measured the peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistive index (RI) of the anterior cerebral artery (ACA), middle cerebral artery (MCA) and posterior cerebral artery (PCA) in neonates using both conventional and Ultrafast Doppler US and acquisition times were compared. Distal ACA branches were assessed with Ultrafast Doppler US.Results: A total of 138 neonates were included. The PSV and EDV of the cranial arteries were comparable between the two Doppler methods (PSV, 64.6-85.5 cm/s vs. 63.4-84.1 cm/s, p=0.100-0.510; EDV, 19.1-26.5 cm/s vs. 17.8-24.2 cm/s, p=0.100-0.981). The RIs of the ACA and PCA were not significantly different (0.69-0.73 vs 0.68-0.74, p=0.174-0.810). Ultrafast Doppler US required shorter acquisition times than conventional Doppler US (6.7 s vs. 11.0 s, p=0.003). The PSV and EDV of the distal ACA were higher than the proximal ACA (20.1-63.3 cm/s vs. 9.4-36.7, p<0.001) although the RI was similar (0.69 vs. 0.68, p=0.251).Conclusions: Ultrafast Doppler US provides comparable values to conventional Doppler US with shorter acquisition times. This novel imaging technique provides quantitative information and is suitable for distal cranial artery evaluation.

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DOPPLER FLOW VELOCITY IN ANTERIOR CEREBRAL ARTERY FOR PREDICTION OF OUTCOME AFTER PERINATAL ASPHYXIA

The Lancet ◽

10.1016/s0140-6736(87)90203-0 ◽

1987 ◽

Vol 329 (8532) ◽

pp. 562 ◽

Cited By ~ 3

Author(s):

LyaDen Ouden ◽

Frank Van Bel ◽

Margot Van De Bor ◽

Theo Stijnen ◽

Jan Ruys ◽

...

Keyword(s):

Flow Velocity ◽

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Perinatal Asphyxia ◽

Prediction Of Outcome ◽

Doppler Flow

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nSeP: immune and metabolic biomarkers for early detection of neonatal sepsis—protocol for a prospective multicohort study

BMJ Open ◽

10.1136/bmjopen-2021-050100 ◽

2021 ◽

Vol 11 (12) ◽

pp. e050100

Author(s):

Mallinath Chakraborty ◽

Patrícia R S Rodrigues ◽

W John Watkins ◽

Angela Hayward ◽

Alok Sharma ◽

...

Keyword(s):

Research Ethics ◽

Neonatal Sepsis ◽

Large Scale ◽

Late Onset ◽

Newborn Infants ◽

Ethics Committee ◽

Suspected Sepsis ◽

New Host ◽

Research Ethics Committee ◽

Study Results

IntroductionDiagnosing neonatal sepsis is heavily dependent on clinical phenotyping as culture-positive body fluid has poor sensitivity, and existing blood biomarkers have poor specificity.A combination of machine learning, statistical and deep pathway biology analyses led to the identification of a tripartite panel of biologically connected immune and metabolic markers that showed greater than 99% accuracy for detecting bacterial infection with 100% sensitivity. The cohort study described here is designed as a large-scale clinical validation of this previous work.Methods and analysisThis multicentre observational study will prospectively recruit a total of 1445 newborn infants (all gestations)—1084 with suspected early—or late-onset sepsis, and 361 controls—over 4 years. A small volume of whole blood will be collected from infants with suspected sepsis at the time of presentation. This sample will be used for integrated transcriptomic, lipidomic and targeted proteomics profiling. In addition, a subset of samples will be subjected to cellular phenotype and proteomic analyses. A second sample from the same patient will be collected at 24 hours, with an opportunistic sampling for stool culture. For control infants, only one set of blood and stool sample will be collected to coincide with clinical blood sampling. Along with detailed clinical information, blood and stool samples will be analysed and the information will be used to identify and validate the efficacy of immune-metabolic networks in the diagnosis of bacterial neonatal sepsis and to identify new host biomarkers for viral sepsis.Ethics and disseminationThe study has received research ethics committee approval from the Wales Research Ethics Committee 2 (reference 19/WA/0008) and operational approval from Health and Care Research Wales. Submission of study results for publication will involve making available all anonymised primary and processed data on public repository sites.Trial registration numberNCT03777670

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Using Doppler sonography resistive index for the diagnosis of perinatal asphyxia: a multi-centered study

10.21203/rs.3.rs-49582/v1 ◽

2020 ◽

Author(s):

Parisa Pishdad ◽

Fatemeh Yarmahmoodi ◽

Tannaz Eghbali ◽

Peyman Arasteh ◽

Seyyed Mostajab Razavi

Keyword(s):

Cerebral Artery ◽

Predictive Value ◽

Doppler Sonography ◽

Perinatal Asphyxia ◽

Negative Likelihood Ratio ◽

Resistive Index ◽

Characteristic Analysis ◽

Mri Findings ◽

Diagnostic Modality ◽

Basilar Arteries

Abstract Background and objectiveInhere we evaluated the efficacy of Doppler sonography (DS) of the anterior cerebral artery (ACA), middle cerebral artery (MCA) and the basilar arteries (BA) based on resistive index (RI) for the diagnosis of asphyxia.MethodsIn this multi-centered cross-sectional study, neonates with clinical diagnosis of asphyxia, were considered for study. During the first 24 hours, neonates underwent DS. MRI was done for each neonate during the first month, after discharge or during hospital admission, after obtaining clinical stability. Staging based on DS was compared with staging based on MRI.ResultsOverall, 34 patients entered the study. DS of the ACA, MCA, BA all had significant correlation with MRI findings (regarding severity of asphyxia) (r>0.8 and p<0.001).In the receiver-operating-characteristic analysis, ideal cut-off point for diagnoses of asphyxia based on ACA and BA was RI≤0.62 [area under the curve (AUC) =0.957 and 95% CI: 0.819-0.997; sensitivity=95.65; specificity=100; positive predictive value (PPV) =100; negative predictive value (NPV) =90.9 and negative likelihood ratio (NLR) =0.043]. Regarding MCA, similarly, a RI≤0.62 was ideal for differentiating between normal and asphyxiated neonates (AUC=0.990 and 95% CI: 0.873-1; sensitivity=91.30; specificity=100; PPV=91.2; NPV=100 and NLR=0.087).ConclusionFor evaluating neonates clinically suspected of asphyxia, DS can be used as a first line diagnostic modality and RI of ≤0.62 is an appropriate cut-off for the diagnosis of perinatal asphyxia.

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Partial Gyrus Rectus Resection as a Technique to Improve the Exposure to the Anterior Communicating Artery Complex through the Junctional Triangle: A Quantitative Study

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1710517 ◽

2020 ◽

Author(s):

Daniel Valli ◽

Xiaochun Zhao ◽

Evgenii Belykh ◽

Qing Sun ◽

Michael T. Lawton ◽

...

Keyword(s):

Standard Deviation ◽

Outcome Measures ◽

Quantitative Study ◽

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Anterior Communicating Artery ◽

Pterional Approach ◽

Before And After ◽

The Mean ◽

Gyrus Rectus

Abstract Objective The junctional triangle, formed by the distal A1 anterior cerebral artery (ACA) segment, the proximal A2 ACA segment, and the medial surface of gyrus rectus (GR), is a corridor of access to superiorly and posteriorly projecting anterior communicating artery (AComA) aneurysms that is widened by GR retraction or resection. Exposure of the AComA complex through the junctional triangle after GR resection has not been previously quantitatively evaluated. Design GR resection extent and increase in artery exposure through the junctional triangle were assessed in this study. Setting This study was conducted in the laboratory with a pterional approach, exposing the AComA complex. Participants Ten sides of five cadaveric heads were considered. Main Outcome Measures Exposure extent of ipsilateral and contralateral A1, A2, and AComA and accessibility of branches coming off the AComA complex were measured before and after GR resection. The GR was resected until sufficient bilateral A2 and contralateral A1 exposures were achieved. GR resection span was measured. Results The mean (standard deviation) resected span of GR was 7 ± 3.9 mm. After GR resection, the exposed span of the ipsilateral A2 increased from 2 ± 0.7 mm to 4 ± 1.1 mm (p = 0.001); contralateral A2 exposure increased from 3 ± 1.5 mm to 4 ± 1.1 mm (p = 0.03). Contralateral recurrent artery of Heubner (RAH) and orbitofrontal artery were accessible in five and eight specimens, respectively, before GR resection and in all 10 after resection. Conclusion GR resection improves exposure of bilateral A2 segments through the junctional triangle. Exposure improvement is greater for the ipsilateral A2 than contralateral A2. The junctional triangle concept is enhanced by partial GR resection during surgery for superior and posterior AComA aneurysms.

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Hemodynamic Changes in Umbilical Artery and Middle Cerebral Artery With Oligohydramnios in Third Trimester of Pregnancy

Journal of Diagnostic Medical Sonography ◽

10.1177/87564793211051978 ◽

2021 ◽

pp. 875647932110519

Author(s):

Zara Jabeen ◽

Raham Bacha ◽

Zain-ul-Hassan ◽

Mehreen Fatima ◽

Iqra Manzoor ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Umbilical Artery ◽

Abdominal Wall Defect ◽

Resistive Index ◽

Third Trimester ◽

Hemodynamic Changes ◽

Cross Sectional ◽

The Mean ◽

Doppler Indices

Objective: The objective of this study was to determine the hemodynamic changes in the umbilical artery (UA) and middle cerebral artery (MCA) with oligohydramnios, during third trimester of pregnancy. Materials and Methods: A cross-sectional descriptive study was done in a perinatal ultrasound center, over a 9-month period. The participant sample size was 64, and all of the women were conveniently consented and selected for the study. All individuals were referred for obstetrical sonography in the third trimester, with oligohydramnios. All fetal anomalies, such as a neural tube defect, dwarfism, an abdominal wall defect, were excluded from the study. Results: The mean systolic to diastolic (S/D) ratio for the UA was 3.01, within a range of 1.49 to 5.60 (± 0.79 SD). The mean pulsatility index (PI), of the UA, was 1.11, within a range of 0.41 to 5.51 cm (± 0.64 SD). The mean resistive index (RI) of the UA was 0.66, within a range of 0.33 to 1.25 cm (± 0.13 SD). The mean S/D ratio of the MCA was 5.68, within a range of 2.05 to 26.10 (± 3.10 SD). The mean PI of the MCA was 1.67 within a range of 0.75 to 2.55 cm (± 0.45 SD). The mean resistive index (RI), of the UA, was 0.82 within a range of 0.51 to 1.77 cm (± 0.82 SD). Conclusion: The Doppler indices may rise as pregnancy advances, especially in fetuses with oligohydramnios. In these types of patients, the flow within the MCA may decrease, with an increase in the gestational age. Consequently, it appears that oligohydramnios may lead to vascular remodeling of the UA and MCA.

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Acute isolated anterior cerebral artery infarcts: A clinical – radiological study

Neurology Asia ◽

10.54029/2021yks ◽

2021 ◽

Vol 26 (3) ◽

pp. 459-464

Author(s):

Sanjith Aaron ◽

Divyan Pancharatnam ◽

Amal Al Hashmi

Keyword(s):

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Anatomical Variations ◽

National Institutes Of Health ◽

Stroke Severity ◽

Limb Weakness ◽

Ct Angiogram ◽

The Mean ◽

Toast Classification ◽

Stroke Centre

Background: The anterior cerebral artery (ACA) supplies many eloquent areas and can have anatomical variations making ACA strokes clinically and radiologically challenging. This study looks at the clinical and radiological features of isolated acute ACA strokes from a stroke centre in Oman. Methods: A retrospective study conducted over a 2 year period on ACA strokes presenting within 12 hours of symptom onset. TOAST classification was used for aetiology. National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) were used to assess stroke severity. Fischer’s classification was used for assessing the arterial segments with CT angiogram. Heidelberg Bleeding Classification was used for haemorrhagic conversion. Results: Isolated ACA strokes constituted 25/1180 (2.1 %) of ischemic strokes. Males 15/25 (60%) Mean age was 68.4 years (Range 42 -97 years). Twenty eight percent of patients had earlier strokes. Hemiparesis (68%) was the commonest clinical presentation. Twenty percent had only lower limb weakness. Hypertension 22/25 (88%) followed by diabetes mellitus 12/25 (48%) was the commonest risk factor. The mean NIHSS was 9 (range 3 to 13). In 36% of patients there was progression of stroke. Plain CT Picked the infarct only in 6/24 (25%). Left side involvement in 18/25 (72%) Artery of Hubner was involved in 6/25 (24%); 44% had an embolic aetiology. There was no mortality and at discharge, 11/25 (44%) had mRS3 or less. Conclusions: In acute ACA infarcts a CT scan can miss the diagnosis in 74%. An embolic aetiology has to be considered in any Isolated ACA stroke and the outcome appears to be good.

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Neonatal sepsis-blood culture, antibiotic stewardship and clinico-bacteriological study

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20205100 ◽

2020 ◽

Vol 7 (12) ◽

pp. 2376

Author(s):

Purva Shah ◽

Ketan Gadhvi ◽

Bharat Muliya ◽

Khushi Shah

Keyword(s):

Neonatal Sepsis ◽

Neonatal Intensive Care ◽

Late Onset ◽

Newborn Infants ◽

Tertiary Hospital ◽

Resistance Pattern ◽

Bacteriological Study ◽

Mortality And Morbidity ◽

Early Onset Sepsis ◽

Septic Focus

Background: Neonatal sepsis refers to an infection involving bloodstream in newborn infants less than 28 days old. It continues to remain a leading cause of morbidity and mortality among infants, especially in middle and lower-income countries. Neonatal sepsis is divided into 2 groups based on the time of presentation after birth: early-onset sepsis and late-onset sepsis.Methods: This study was done in the neonatal intensive care unit of tertiary hospital, Surendranagar. Study design being observational, data collected from clinical examination and records of the neonates admitted with positive septic screen, neonates admitted with suspected clinical sepsis (temperature >990F or <950F, respiratory rate more than 60 per minute, change in behavior, abnormal cry, not accepting feed, drowsy or unconscious, septic focus on skin or umbilicus, diarrhea and seizures) and neonates admitted with culture positive sepsis.Results: As per this research, neonatal sepsis has more male preponderance, with more commonly occurring in low birth weights and preterm. Klebsiella, Staphylococcus aureus and Pseudomonas being the most isolated organisms. Their resistance pattern, antibiotic profile and newer trends also came across.Conclusions: Neonatal sepsis comes as one of the major causes of mortality and morbidity of the newborns admitted. By this research, analyzing the sex, age, gestational weeks, organism isolated and the antibiotic profile, emerging new resistance and newer useful antibiotics can thus be studied and can be taken as a base for further study as well as evaluation of the same, along with also guiding to manage and treat neonatal sepsis better.

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