Abstract： Objective To evaluate the effect of cerebral blood flow perfusion in very preterm infants with fetal distress by arterial spin labeling (ASL) imaging technique.Method Using a prospective cohort study method,a total of 53 very preterm infants who were born and hospitalized in the Department of Neonatology,the Third Affiliated Hospital of Zhengzhou University from August 2021 to April 2023 were selected as the research objects.According to the presence or absence of fetal distress,they were divided into distress group (n=22) and non-distress group (n=31).The differences in cerebral blood flow in different regions of interest of brain tissue between the two groups were analyzed.The correlation between fetal distress and cerebral blood flow changes was analyzed by multiple linear regression analysis.Independent sample t-test or correction t-test,Mann-Whitney U test and x2 test or Fisher exact probability methodwere used for statistical analysis.Result The proportion of singletons was significantly higher in the distress group than in the non-distress group[81.8% (18/22) vs 54.8% (17/31),x2=4.176,P<0.05].In the very preterm infants,the cerebral blood flow (CBF) in the bilateral frontal lobes[left:23.9 (21.7,28.0) ml/(100 g·min) vs 21.5 (18.2,23.8) ml/(100 g·min),t=-2.826;right:(24.5±0.9) ml/(100 g·min) vs (21.2±0.8) ml/(100 g·min),t=2.773],bilateral temporal lobes[left:(22.8±0.9) ml/(100 g·min) vs (19.8±0.6) ml/(100 g·min),t=2.834;right:(23.2±0.9) ml/(100 g·min) vs (20.8±0.7) ml/(100 g·min),t=2.108],bilateral parietal lobes[left:(24.0±1.1) ml/(100 g·min) vs (19.4±0.8) ml/(100 g·min),t=3.377;right:25.6 (18.9,28.1) ml/(100 g·min) vs 19.6 (16.3,22.5) ml/(100 g·min),t=-2.311],bilateral occipital lobes[left:(25.7±1.4) ml/(100 g·min) vs (21.2±0.9) ml/(100 g·min),t=2.796;right:(26.3±1.6) ml/(100 g·min) vs (21.7±1.0) ml/(100 g·min),t=2.583],bilateral basal ganglia[left:(35.4±1.5) ml/(100 g·min) vs (29.0±0.8) ml/(100 g·min),t'=3.872;right:(34.9±1.4) ml/(100 g·min) vs (29.3±1.0) ml/(100 g·min),t=3.457],and bilateral thalami[left:(40.0±2.0) ml/(100 g·min) vs (35.0±1.3) ml/(100 g·min),t=2.157;right:(40.5±1.7) ml/(100 g·min) vs (35.1±1.1) ml/(100 g·min),t=2.783]were significantly higher in the distress group than in the non-distress group (all P<0.05).After adjusting for confounders using a multiple linear regression model (singleton,birth weight,gestational age at birth,corrected gestational age at the time of ASL,gender,most recent hematocrit at the time of ASL,duration of assisted ventilation,placenta previa,placental abruption,umbilical cord abnormality,meconium-stained amniotic fluid,hypertensive disorders of pregnancy and diabetes,and acute chorioamnionitis),fetal distress was still associated with CBF in the bilateral temporal lobes (left:95% CI:0.208～4.941,right:95% CI:0.047-4.636),left frontal lobe (95% CI:0.047-4.636),and bilateral basal ganglia (left:95% CI:2.230-8.983,right:95% CI:1.503-8.912) (all P<0.05).Conclusion The CBF values of each region of interest in the brain after birth are quantitatively measured by ASL imaging technology,and it is found that fetal distress can increase the blood flow perfusion of bilateral temporal cortex left parietal lobe and bilateral basal ganglia in very preterm infants,which may lead to an increased risk of brain injury in very preterm infants.