Resistive Index Changes of Anterior Cerebral Artery among Neonates Receiving Delivery Room Resuscitation: A Comparative Study from South India

A BSTRACT Background: Perinatal asphyxia (PA) leads to hypoxemia, hypercarbia, and metabolic acidosis, causing multiorgan dysfunction. Measurement of resistive index (RI) using point-of-care ultrasonography aids in enhancing the prognosis in neonates with PA. The current study was undertaken to evaluate the diagnostic accuracy of RI in assessing hypoxic ischemic encephalopathy (HIE) and its association with therapeutic hypothermia, amplitude-integrated electroencephalography (aEEG) changes, and the Thompson score. Methodology: A hospital-based analytical observational study was conducted with 40 neonates receiving delivery room resuscitation and 40 healthy neonates. RI was measured at 6, 12, 24, and 48 h using Doppler ultrasound. Results: There was a significant correlation between RI and HIE. At 6 h, RI was significantly higher in severe HIE cases as compared to controls ( P < 0.001). ROC analysis revealed that the optimal RI cutoff for predicting severe HIE was of 0.87 (75% sensitivity and 100% specificity). RI also showed significant correlation with Thompson scores and aEEG changes. Cases with high and lower RI were more likely to receive therapeutic hypothermia. Conclusions: RI is a reliable biomarker for predicting HIE in neonates requiring delivery room resuscitation. A higher RI is associated with increased HIE severity, abnormal electroencephalogram findings, and the need for therapeutic hypothermia. Early RI measurement may help identify neonates at risk for HIE.