ANTERIOR CEREBRAL ARTERY RESISTIVE INDEX AND GRAYSCALE CRANIAL ULTRASOUND FINDINGS IN PRETERM NEONATES: A PROSPECTIVE DESCRIPTIVE STUDY AT A NATIONAL MILITARY REFERRAL HOSPITAL IN JAKARTA, INDONESIA

Abstract

Introduction: Immature cerebral autoregulation renders the preterm brain vulnerable to haemodynamic injury. The Doppler resistive index (RI) of the anterior cerebral artery (ACA) is a bedside surrogate of cerebrovascular resistance, yet no Indonesian data exist. This study described ACA RI and grayscale cranial ultrasound (CUS) findings in preterm neonates. Methods: This prospective descriptive study enrolled preterm neonates (<37 weeks) admitted to the neonatal intensive care unit of RSPAD Gatot Soebroto, Jakarta, from May to July 2026. Grayscale CUS and pulsed-wave Doppler of the bilateral ACA (A2 segment, ≥3 cardiac cycles per side) were performed within the first seven days of life. RI was summarised by gestational age (GA) and categorised as low, normal or high against GA-specific bands. Results: Of 45 neonates, 30 were analysed (32–<37 weeks, 60.0%; 28–31 weeks, 36.7%; <28 weeks, 3.3%). Respiratory distress syndrome (40.0%) and sepsis (36.7%) were the leading comorbidities; asphyxia was absent. Median ACA RI was 0.64 (IQR 0.09) at 32–<37 weeks, 0.68 (IQR 0.07) at 28–31 weeks and 0.86 in the single infant <28 weeks. Low RI predominated (53.3%; 95% CI 36.1–69.8); high RI occurred in 13.3%. Cerebral oedema was the commonest grayscale finding (56.7%), followed by normal scans (40.0%) and grade I haemorrhage (3.3%); periventricular leukomalacia and ventriculomegaly were absent. Discussion: ACA RI showed a descriptive inverse gradient with GA, and Doppler abnormalities occurred in grayscale-normal brains, although inter-stratum differences were not statistically significant. Conclusion: Integrated grayscale–Doppler CUS yields locally derived cerebral haemodynamic data for Indonesian preterm neonates; larger multicentre studies are warranted.