Transcranial Doppler and Umbilical Cord Arterial pH as Predictors of Short-term Neurological Outcome in Nonvigorous Neonates: A Prospective Cohort Study

A BSTRACT Background: Nonvigorous neonates are at increased risk of hypoxic–ischemic encephalopathy (HIE) and early neurological injury. Umbilical cord arterial blood (UCAB) pH reflects intrapartum hypoxia but does not capture postnatal cerebral hemodynamic alterations. Transcranial Doppler (TCD) ultrasonography enables bedside assessment of cerebral autoregulation and provides complementary prognostic information. Objectives: To assess the correlation between TCD parameters of the middle cerebral artery (MCA) and UCAB pH in nonvigorous newborns at birth, and to evaluate their association with short-term neurological outcome. Materials and Methods: This prospective cohort study was conducted in the postnatal ward of a tertiary care center. Term and late preterm newborns (34–40 weeks gestation) who were nonvigorous at birth were enrolled. UCAB pH was measured immediately after birth. TCD ultrasonography of MCA was performed on day 1 of life to assess peak systolic velocity, end-diastolic velocity, resistive index (RI), and pulsatility index. Short-term neurological outcome was evaluated at discharge using the Hammersmith Neonatal Neurological Examination (HNNE). Results: Forty-nine neonates were included. Lower UCAB pH values were associated with increasing severity of HIE and poorer neurological outcomes. UCAB pH showed a positive correlation with total HNNE score ( P = 0.020), and severe acidemia was associated with significantly lower HNNE scores ( P = 0.007). Abnormal TCD RI was significantly associated with higher HIE stage, suboptimal neurological outcome, and mortality. No significant correlation was observed between UCAB pH and TCD parameters. Conclusions: UCAB pH and early TCD indices evaluate complementary aspects of hypoxic brain injury. Their combined use enhances early neurological risk stratification in nonvigorous neonates.