End-diastolic velocity as a simplified bedside predictor of estimated cerebral perfusion pressure in neonates: A multicentre prospective observational study.

AIM: To elucidate the relationship between estimated cerebral perfusion pressure and cerebral blood flow velocities or resistance index in neonates and to identify optimal Doppler cut-off values for predicting estimated cerebral perfusion pressure. METHODS: This multicentre study included neonates with arterial lines admitted to neonatal intensive care units between December 2021 and August 2024. Estimated cerebral perfusion pressure, cerebral blood flow velocities, and resistance index were calculated daily from the middle cerebral artery. RESULTS: A total of 446 samples were obtained from 137 neonates with a median gestational age of 32 (interquartile range, 27-36) weeks and a median birth weight of 1551 (interquartile range, 928-2292) g. End-diastolic velocity showed the strongest correlation with estimated cerebral perfusion pressure (standardised β = 0.571, 95% confidence interval, 0.500-0.641, p < 0.001). End-diastolic velocity cut-off values increased stepwise with higher estimated cerebral perfusion pressure thresholds. CONCLUSION: End-diastolic velocity is a strong predictor of neonatal estimated cerebral perfusion pressure and may serve as a practical indicator of cerebral perfusion in neonatal intensive care units.