{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T06:07:39Z","timestamp":1774505259702,"version":"3.50.1"},"reference-count":29,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2023,6,21]],"date-time":"2023-06-21T00:00:00Z","timestamp":1687305600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>The velocity time integral (VTI) is a clinical Doppler ultrasound measurement of blood flow, measured by the area under the wave curve and equivalent to the distance traveled by the blood. This retrospective study assessed the middle cerebral artery (MCA) VTI of fetuses in pregnancies complicated by maternal alloimmunization. Doppler indices of the MCA were retrieved from electronic medical records. Systolic deceleration-diastolic time, systolic acceleration time, VTI, and peak systolic velocity (PSV) were measured at 16\u201340 weeks gestation. Cases with PSV indicating fetal anemia (cutoff 1.5 MoM) and normal PSV were compared. The study included 255 Doppler ultrasound examinations. Of these, 41 were at 16\u201324 weeks (group A), 100 were at 25\u201332 weeks (group B), and 114 were at 33\u201340 weeks (group C). VTI increased throughout gestation (5.5 cm, 8.6 cm, and 12.1 cm in groups A, B, and C, respectively, p = 0.003). VTI was higher in waveforms calculated to have MCA-PSV \u2265 1.5 MoM compared to those with MCA-PSV &lt; 1.5 MoM (9.1 cm vs. 14.1 cm, respectively, p &lt; 0.001), as was VTI\/s (22.04 cm\/s vs. 33.75 cm\/s, respectively; p &lt; 0.001). The results indicate that the MCA VTI increases significantly among fetuses with suspected anemia, indicating higher perfusion of hemodiluted blood to the brain. This feasible measurement might provide a novel additional marker for the development of fetal anemia.<\/jats:p>","DOI":"10.3390\/children10071090","type":"journal-article","created":{"date-parts":[[2023,6,21]],"date-time":"2023-06-21T01:35:11Z","timestamp":1687311311000},"page":"1090","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Velocity Time Integral: A Novel Method for Assessing Fetal Anemia"],"prefix":"10.3390","volume":"10","author":[{"given":"Ettie","family":"Piura","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel"},{"name":"Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Offra","family":"Engel","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel"},{"name":"Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neta","family":"Doctory","sequence":"additional","affiliation":[{"name":"Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nisim","family":"Arbib","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel"},{"name":"Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tal","family":"Biron-Shental","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel"},{"name":"Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michal","family":"Kovo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel"},{"name":"Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6765-1583","authenticated-orcid":false,"given":"Shmuel","family":"Arnon","sequence":"additional","affiliation":[{"name":"Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"},{"name":"Department of Neonatology, Meir Medical Center, Kfar Saba 4428164, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1788-4143","authenticated-orcid":false,"given":"Ofer","family":"Markovitch","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel"},{"name":"Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1046\/j.1469-0705.1995.05060400.x","article-title":"Diagnosis of fetal anemia with doppler ultrasound in the pregnancy complicated by maternal blood group immunization","volume":"5","author":"Mari","year":"1995","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1056\/NEJM200001063420102","article-title":"Noninvasive diagnosis by doppler ultrasonography of fetal anemia due to maternal red cell alloimmunization","volume":"342","author":"Mari","year":"2000","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1056\/NEJMoa052855","article-title":"Doppler ultrasonography versus amniocentesis to predict fetal anemia","volume":"355","author":"Oepkes","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"17S","DOI":"10.1097\/01.AOG.0000663084.35334.7e","article-title":"The limitations of middle cerebral artery peak systolic velocity and the need for certification","volume":"135","author":"Mayer","year":"2020","journal-title":"Obstet. Gynecol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"8226","DOI":"10.1080\/14767058.2021.1967316","article-title":"Performance of middle cerebral artery doppler for prediction of recurrent fetal anemia","volume":"35","author":"Oakes","year":"2022","journal-title":"J. Matern. Neonatal Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2014","DOI":"10.1111\/echo.14176","article-title":"Reference intervals and percentile curve for left ventricular outflow tract (LVOT), velocity time integral (VTI), and LVOT-VTI deprived hemodynamic parameters in healthy children and adolescents: Analysis of echocardiographic methods association and agreement","volume":"35","author":"Diaz","year":"2018","journal-title":"Echocardiography"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s13089-020-00170-x","article-title":"Rationale for using the velocity-time integral and the minute distance for assessing the stroke volume and cardiac output in point-of-care settings","volume":"12","author":"Blanco","year":"2020","journal-title":"Ultrasound J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1016\/j.jemermed.2022.04.012","article-title":"A bedside echocardiography technique finding a place in the emergency department","volume":"63","author":"Parker","year":"2022","journal-title":"J. Emerg. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e116","DOI":"10.1016\/j.bja.2022.07.037","article-title":"Automation of sub-aortic velocity time integral measurements by transthoracic echocardiography: Clinical evaluation of an artificial intelligence-enabled tool in critically ill patients","volume":"129","author":"Gonzalez","year":"2022","journal-title":"Br. J. Anaesth."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1159\/000519322","article-title":"Maternal hyperoxygenation testing in fetuses with hypoplastic left-heart syndrome: Association with postnatal atrial septal restriction","volume":"48","author":"Mardy","year":"2021","journal-title":"Fetal Diagn. Ther."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2974","DOI":"10.1161\/CIRCULATIONAHA.105.534180","article-title":"Predictive value of fetal pulmonary venous flow patterns in identifying the need for atrial septoplasty in the newborn with hypoplastic left ventricle","volume":"112","author":"Michelfelder","year":"2005","journal-title":"Circulation"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1470","DOI":"10.1016\/j.echo.2019.06.011","article-title":"The diastolic and systolic velocity-time integral ratio of the aortic isthmus is a sensitive indicator of aortic coarctation in fetuses","volume":"32","author":"Wang","year":"2019","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1558","DOI":"10.1111\/j.1471-0528.2009.02255.x","article-title":"Noninvasive methods of detecting fetal anemia: A systemic review and meta-analysis","volume":"116","author":"Pretlove","year":"2009","journal-title":"BJOG"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1113\/JP271099","article-title":"The fetal brain sparing response to hypoxia: Physiological mechanisms","volume":"594","author":"Giussani","year":"2016","journal-title":"J. Physiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.echo.2014.09.009","article-title":"Guidelines for the use of echocardiography as a monitor for therapeutic intervention in adults: A report from the American Society of Echocardiography","volume":"28","author":"Porter","year":"2015","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1097\/ALN.0b013e318229a500","article-title":"An increase in aortic blood flow after an infusion of 100 mL colloid over 1 minute can predict fluid responsiveness: The mini-fluid challenge study","volume":"115","author":"Muller","year":"2011","journal-title":"Anesthesiology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1186\/cc12526","article-title":"Assessment of volume responsiveness during mechanical ventilation: Recent advances","volume":"17","author":"Monnet","year":"2013","journal-title":"Crit. Care"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1007\/s00134-007-0642-y","article-title":"Diagnosis of central hypovolemia by using passive leg raising","volume":"33","author":"Maizel","year":"2007","journal-title":"Intensiv. Care Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1007\/s00134-007-0646-7","article-title":"Echocardiographic prediction of volume responsiveness in critically ill patients with spontaneously breathing activity","volume":"33","author":"Lamia","year":"2007","journal-title":"Intensiv. Care Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s13049-019-0586-6","article-title":"Emergency department non-invasive cardiac output study (EDNICO): A feasibility and repeatability study","volume":"27","author":"McGregor","year":"2019","journal-title":"Scand. J. Trauma Resusc. Emerg. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s13089-018-0114-3","article-title":"Mitral valve velocity time integral and passive leg raise as a measure of volume responsiveness","volume":"10","author":"Wuhantu","year":"2018","journal-title":"Crit. Ultrasound J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1203\/01.PDR.0000113785.66455.E7","article-title":"Different responses of myocardial and cerebral blood flow in cord occlusion in exteriorized fetal sheep","volume":"55","author":"Ley","year":"2004","journal-title":"Pediatr. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1515\/jpm-2019-0176","article-title":"Doppler evaluation of the posterior cerebral artery in fetuses with transposition of great arteries","volume":"25","author":"Tan","year":"2020","journal-title":"J. Perinat. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1093\/brain\/108.1.81","article-title":"Fundamental importance of arterial oxygen content in regulation of cerebral blood flow in man","volume":"108","author":"Brown","year":"1985","journal-title":"Brain"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1097\/00004647-200110000-00007","article-title":"Apoptotic and antiapoptotic mechanisms after traumatic brain injury","volume":"21","author":"Keane","year":"2001","journal-title":"J. Cereb. Blood Flow Metab."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1152\/japplphysiol.01315.2006","article-title":"Severe hemodilutional anemia increases cerebral tissue injury following acute neurotrauma","volume":"103","author":"Hare","year":"2007","journal-title":"J. Appl. Physiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1002\/ajh.25727","article-title":"Cerebral oxygen metabolism in adult with sickle cell disease","volume":"95","author":"Petr","year":"2020","journal-title":"Am. J. Hematol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1002\/uog.1035","article-title":"Sonographic demonstration of brain injury in fetuses with severe red blood cell alloimmunization undergoing intrauterine transfusions","volume":"23","author":"Ghi","year":"2004","journal-title":"Ultrasound Obs. Gynecol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1016\/j.clp.2009.06.007","article-title":"Fetal hypoxia insults and patterns of brain injury: Insights from animal models","volume":"36","author":"Gunn","year":"2009","journal-title":"Clin. Perinatol."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/10\/7\/1090\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:57:38Z","timestamp":1760126258000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/10\/7\/1090"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,21]]},"references-count":29,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,7]]}},"alternative-id":["children10071090"],"URL":"https:\/\/doi.org\/10.3390\/children10071090","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,21]]}}}