Purpose or Case Report: Head ultrasound has long been utilized in the first few months of life to screen neonates for hemorrhage, assess midline anatomy, characterize extra-axial fluid collections, elucidate causes for suspected ventriculomegaly, and serially evaluate parenchymal echotexture without exposing the child to ionizing radiation or the expense of MRI. Less commonly utilized in a routine fashion is Doppler interrogation of the midline vasculature as part of the inpatient routine head ultrasound protocol. This exhibit will educate the reader on how and when transfontanelle Doppler can be utilized and the benefits it can provide.
Methods & Materials: The routine use of transfontanelle Doppler interrogation of the intracranial vasculature is described. Using medical illustrations and relevant images from patient exams, the correct positioning and acquisition of images is shown. A review of the relevant anatomy is performed. Correlation of ultrasound abnormalities with MRI results is provided. Use in patients undergoing ECMO is highlighted. Pitfalls and tips to improve imaging are described. Comparisons to transcranial Doppler are made using correlational diagrams.
Results: The transfontanelle Doppler can provide valuable clues to diagnosis. Abnormal resistive indices can have prognostic value in the setting of hypoxic ischemic encephalopathy and for patients on extracorporeal membrane oxygenation. Specifically, abnormally low resistive indices in the perinatal period have been shown to have a positive predictive value of 71% for adverse outcomes.

Doppler has also been shown to add value to ultrasound evaluation of patients with known brain damage, whether due to ischemia, infection, or hemorrhage. Extra-axial fluid collections can affect Doppler values. Interestingly, in patients who have had recent cardiac surgery, elevated resistive indices have been shown to be associated with improved neurodevelopmental outcomes.
Conclusions: Transfontanelle Doppler has been shown to add valuable information in multiple clinical scenarios. Transfontanelle Doppler evaluation is feasible with little additional training and should be performed as part of the routine head ultrasound protocol on inpatient neonates.