Absent or reversed end-diastolic flow in the umbilical artery is an independent predictor of either neonatal death or cerebral palsy in preterm growth-restricted fetuses. In the absence of fetal growth restriction, umbilical artery Doppler study was associated with none of the infant outcome parameters studied.

Objective To assess the risk of persistent ( > 7 days) increases in brain parenchymal echogenicity in preterm infants and their association with known obstetric risk factors. Design Case -control study of prospectively collected data.Setting A University hospital in Northern Italy.Population Eighty-five singleton infants between 24 and 34 weeks of gestation with a cranial ultrasonographic diagnosis of persistently increased parenchymal echogenicity without development of cystic degeneration, and 170 control infants with negative cranial ultrasonographic findings. Methods A comparison of the prevalence of selected obstetric risk factors between infants with persistent echo-dense lesions and negative controls. Main outcome measures Odds ratios of persistent echo-dense lesions including first-degree interactions between variables. Results After adjusting for birthweight, logistic regression analysis showed that the only factor associated with an increased risk of persistent brain echo-dense lesions in infants was multiple courses of antenatal steroids (OR ¼ 2.14, 95% CI ¼ 1.11 -4.15, P ¼ 0.024). In this group, the risk of persistent echo-dense lesions was particularly high in: (i) mothers receiving dexamethasone rather than betamethasone (P value for interaction ¼ 0.015) and (ii) after expectant management of pre-eclampsia or intrauterine growth retardation (P value for interaction ¼ 0.03). Conclusions Multiple doses of antenatal steroids, especially dexamethasone, could influence the prevalence of persistent increases in brain parenchymal echogenicity in preterm infants.

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