A scoping review of variations in cerebral Doppler venous waveforms in infants

• Provides the first scoping review of cerebral venous Doppler waveforms in infants less than one year • Synthesizes findings from 37 studies and 205 cerebral venous waveforms • Presents an atlas of Doppler venous waveforms showing normal and pathological flow patterns to guide clinical management • Identifies waveform changes associated with conditions such as intraventricular hemorrhage, Extracorporeal Membrane Oxygenation (ECMO) therapy, mechanical ventilation and vein of Galen malformation • Discusses the effects of head positioning and external compression on venous drainage Advances in ultrasound technology have positioned cerebral venous Doppler as a valuable method for evaluating cerebral hemodynamics, complementing arterial velocity assessments. This scoping review provides an overview of normal and abnormal venous waveforms that can guide management. A systematic search in three bibliographic databases identified 5320 unique records, of which 37 studies met inclusion criteria, reporting 205 cerebral venous Doppler waveforms from at least three infants under one year old. These studies describe both physiological variation and changes associated with lesions and medical interventions, most commonly reported using velocity-based parameters. Six studies employed a total of three different scoring systems to characterize velocity fluctuations. An atlas of cerebral venous Doppler waveforms was compiled. It highlights differences between the superficial and deep venous systems and identifies characteristic pathological changes. These include velocity fluctuation in the internal cerebral vein associated with germinal matrix and intraventricular hemorrhage; ventilatory- and extracorporeal membrane oxygenation (ECMO) pump-synchronous flow in the superior sagittal sinus; and perioperative velocity monitoring in the superior sagittal sinus in cases of Vein of Galen malformation. The review also discusses the impact of head position and external compression on venous drainage. Future studies should deepen understanding of cerebral venous hemodynamics in conditions causing systemic compromise. Investigations into the influence of head position during the transitional period in preterm neonates may help guide clinical management during this critical phase. Longitudinal studies on velocity fluctuation in relation to disease progression and medical interventions may enhance care of preterm and critically ill term infants.