Technical Feasibility, Normal Velocities, and the Impact of Prematurity on Cranial Venous Doppler in Neonates: A Prospective Study and Literature Review

Background: This prospective study aims to establish normal baseline values for intracranial venous Doppler velocities in neonates, assess the stability of these values across different health conditions, and evaluate the feasibility of Doppler ultrasonography in neonatal cerebral venous assessment. Methods: We conducted Doppler ultrasound evaluations of key cranial venous structures in 80 neonates, including healthy term infants, preterm otherwise healthy neonates, and neonates with preterm brain injury. The venous structures assessed included the internal cerebral veins (ICV), vein of Galen (GV), straight sinus (SS), and superior sagittal sinus (SSS). Quantitative analysis of blood flow velocities was performed, and pulsatility patterns were examined in cases of intraventricular hemorrhage (IVH) and children with ventricular dilatation. Results: The study successfully visualized major cranial venous structures in nearly all cases, with healthy term neonates showing mean velocities of 5.14 ± 1.2 cm/s for ICV, 8.42 ± 1.2 cm/s for GV, 17.18 ± 4.57 cm/s for SS, and 14.4 ± 3.91 cm/s for SSS. No significant differences in venous velocities were observed between healthy, preterm, and brain injury groups, suggesting that venous flow is relatively stable across these conditions. Pulsatility analysis did not reveal abnormal patterns in IVH cases, although flat waveforms were observed in children with ventriculomegaly, potentially due to elevated intracranial pressure. Conclusion: This study establishes reliable normal values for neonatal intracranial venous Doppler velocities and demonstrates the feasibility of using Doppler ultrasound for cerebral venous assessment in neonates. The findings suggest that venous flow velocities are not significantly altered by prematurity or brain injury.