163 - Application of Middle Cerebral Artery Doppler Velocimetry for Predicting Neonatal Outcomes in Newborns Identified as Small for Gestational Age

Publication Number: 163.3835

Marwa Khalil, Hackensack Meridian School of Medicine, Hackensack, NJ, United States; Soindos Abdah, Hackensack Meridian School of Medicine, Fairview, NJ, United States; Andrew Brofsky, Hackensack Meridian School of Medicine, Freehold, NJ, United States; Kaitlynn Chaljub, Hackensack Meridian School of Medicine, Wayne, NJ, United States; Tara Lozy, Hackensack Meridian School of Medicine, Hackensack, NJ, United States; Samantha R. Glifort, Joseph M. Sanzari Children's Hospital Hackensack University Medical Center, Sandy, UT, United States; jesus Alvarez-Perez, HUMC, Hackensack, NJ, United States

Background: Fetal growth restriction (FGR) arises from chronic fetal hypoxia due to uteroplacental hypoperfusion. Given its significant role in perinatal morbidity, monitoring pregnancies with FGR using antenatal ultrasound& Doppler velocimetry is crucial. Abnormal umbilical artery Doppler findings are linked to poor neonatal outcomes, however, MCA Doppler flow association with poor neonatal outcomes remains understudied.

Objective: Identify postnatal complications in SGA neonates that can be associated with an abnormal antenatal MCA Doppler flow.

Design/Methods: Retrospective chart review of SGA neonates was performed with review of corresponding antenatal sonograms, pregnancies affected by known chromosomal abnormalities excluded. Bivariate analyses performed using student t-test for continuous variables or chi-square test for categorical variables with a significance threshold 0.05 to identify associations between ultrasound findings &postnatal complications. Results were stratified by diagnosis of FGR ( < 32 wks or ≥ 32 wks)

Results: Antenatal FGR was diagnosed in 242 SGA neonates based on EFW or abdominal circumference < 10th of gestational age (GA). 39.2% diagnosed with FGR at < 32 weeks GA. Maternal chart review showed racial diversity & mean maternal age of 31.9 years (SD = 5.3) &31.6% of mothers were of advanced maternal age. The median BMI was 28.0 (IQR = 25.3 - 31.4) 37.6% had hypertensive disorders, 9.0% had prior IUFD &15.2% had gestational diabetes. Among neonates diagnosed with FGR < 32 weeks, 24.7% showed abnormal pulsatility index (PI) of (MCA) Doppler (n=22, p=.03) compared to 20.3% of those diagnosed at ≥ 32 weeks. Early diagnosis of FGR ( < 32 wks) was associated with significant placental pathology findings e.g placental liquefaction & ischemia (6.5% vs1.4, p=.01) with a higher incidence of echogenic bowel (30.9% vs 16.0%, p=.02). While isolated abnormal PI (MCA) findings alone were not significant (p=.73), abnormal PI became a significant predictor of Gastrointestinal(GI) complications when combined with other variables, such as echogenic bowels (p=.03). GI complications were present in 69.7% of those neonates (p.001).

Conclusion(s): Our data showed antenatal brain-sparing MCA/PI Doppler may not be significant on its own, however, combination of this velocimetry tool & echogenic bowel findings is predictive of GI complications. Future investigations are needed to assess the reliability of our findings in a larger database. This research could lead to creation of antenatal sonographic markers for postnatal complications, enhancing informed care & prenatal counseling for pregnancies affected by FGR.