Correlación entre el Flujo Sanguíneo Retinal y la Hemodinámica Central en --N--eonatos: Analizando cómo las Alteraciones en la Angiogénesis Predicen el Desarrollo de la Leucomalacia Periventricular y Futuros Trastornos del Aprendizaje.

Jairo David Acosta Acurio; Katherine Elizabeth  Perlaza Flores; Eladio Javier Palma Ochoa; Jazmín del Cisne  Cabrera Prieto; Gisell Paulina Salazar Acurio

doi:10.70577/asce.v5i3.1035

Authors

Jairo David Acosta Acurio Investigador independiente https://orcid.org/0009-0002-2303-5030
Katherine Elizabeth Perlaza Flores Investigador independiente https://orcid.org/0000-0002-1866-1603
Eladio Javier Palma Ochoa Investigador independiente https://orcid.org/0009-0000-5139-4458
Jazmín del Cisne Cabrera Prieto Investigador independiente https://orcid.org/0009-0003-2786-540X
Gisell Paulina Salazar Acurio Universidad Regional Autonoma de los Andes https://orcid.org/0000-0003-2200-7978

DOI:

https://doi.org/10.70577/asce.v5i3.1035

Keywords:

Leukomalacia, Periventricular; Regional Blood Flow; Retina; Hemodynamics; Infant, Premature; Ultrasonography, Doppler; Learning Disorders; Angiogenesis.

Abstract

Periventricular leukomalacia (PVL) is the main white matter brain injury in preterm infants, associated with cerebral palsy, visual and cognitive disorders. The retina shares embryological origin and hemodynamic characteristics with brain tissue, suggesting that retinal blood flow assessment could reflect central hemodynamic alterations and predict PVL development and its sequelae. To analyze the correlation between retinal blood flow, assessed by Doppler of the central retinal or ophthalmic artery, and cerebral hemodynamics in preterm neonates, determining its predictive value for periventricular leukomalacia development and future learning disorders. Systematic review and meta-analysis conducted following PRISMA 2020 guidelines. PubMed/MEDLINE, Scopus, Web of Science, EMBASE, and Cochrane Library were searched (January 2000-February 2026). Prospective cohort studies and comparative studies evaluating retinal and cerebral Doppler parameters in preterm infants <32 weeks, with follow-up to school age, were included. Methodological quality was assessed using ROBINS-I and QUADAS-2. Results: A total of 456 records were identified, of which 21 studies met inclusion criteria (n=2,156 patients). Resistive index (RI) in ophthalmic artery showed positive correlation with RI in anterior cerebral artery (r=0.74; 95% CI: 0.61-0.84; p<0.001). Ophthalmic RI >0.85 in first 3 days was associated with PVL development (OR: 5.1; 95% CI: 3.2-8.2; p<0.001) and with learning disorders at 5-7 years (OR: 3.4; 95% CI: 2.1-5.6; p<0.001). Pooled sensitivity of retinal Doppler for predicting PVL was 79% (95% CI: 72-85%) and specificity 83% (95% CI: 76-89%). Practical applications or future research lines: Incorporation of retinal Doppler into hemodynamic monitoring protocols for high-risk preterm infants is proposed. Multicenter studies with standardized protocols and clinical trials evaluating interventions guided by this marker are required. Retinal blood flow, assessed by Doppler, constitutes a non-invasive window to neonatal cerebral hemodynamics. Early elevation of the ophthalmic artery resistive index predicts periventricular leukomalacia development and is associated with learning disorders at school age, allowing early identification of high-risk patients for early intervention.

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