Antenatal predictors of the neurologic sequelae at 3 years of age: a multivariate analysis

Objective: To study the association between fetal blood flow abnormalities and the occurrence of long-term neurologic sequelae. Study design: Umbilica l, aortic and middle cerebral artery blood flow parameters were obtained by Doppler examination and retrospectively analyzed in 128 high-risk singleto n pregnancies, followed by neurologic examination of the surviving children at 3 years of age. Traditional parameters of neurologic outcome (Apgar sco res, intrauterine growth retardation (IUGR), umbilical artery pH and base d eficit, gestational age, birth weight, newborn encephalopathy, mode of deli very, fetal heart rate, neurosonographic examination) were included as poss ible confounding factors. Mann-Whitney U-test, Student's t-test, analysis o f variance or Fisher's exact test, where applicable, were used for the univ ariate analysis. A stepwise logistic regression procedure was conducted to test the independent association of selected perinatal risk factors on neur ological outcome. Statistical significance was assumed at P<0.05. Results: Eighteen out of 114 surviving children suffered neurologic illness at 3 yea rs of age. Four children had major neurologic dysfunction and the remaining 14 suffered minor or mild form of the disease. Although blood flow paramet ers and various perinatal parameters did not differ significantly between t he group of children with major neurologic dysfunction and healthy children , aortic resistance index showed an independent association with occurrence of minor or mild neurologic disabilities. Conclusion: Antenatal evaluation of the aortic blood flow might be an important predictive variable for per manent neurologic disturbances. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.