Comparison of changes in cerebral and systemic perfusion between appropriate- and small-for-gestational-age infants during the first three days after birth

Ishii, Hiroki; Takami, Takeshi; Fujioka, Tao; Mizukaki, Norio; Kondo, Atsushi; Sunohara, Daisuke; Hoshika, Akinori; Akutagawa, Osamu; Isaka, Keiichi

doi:10.1016/j.braindev.2013.06.006

Cited by 29 publications

(43 citation statements)

References 30 publications

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“…It is well known that neonates who were exposed to chronic hypoxia in utero can present with polycythaemia. Increased haematocrit was also reported in some of the studies mentioned previously [46,47,49]. Moreover, changes in vessel wall composition could potentially occur in IUGR [39].…”

Section: Postnatal Cerebral Circulation Following Brain-sparingmentioning

confidence: 71%

“…Moreover, higher regional cerebral oxygen saturation and reduced cerebral oxygen extraction have been reported within the first 24 h of birth [47]. All of these cerebral haemodynamic parameters have shown normalisation within a few days, indicating that the cerebral circulatory differences are transitory [44,46,47]. …”

Section: Postnatal Cerebral Circulation Following Brain-sparingmentioning

confidence: 99%

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Brain-Sparing in Intrauterine Growth Restriction: Considerations for the Neonatologist

2015

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Intrauterine growth restriction (IUGR) is most commonly caused by placental insufficiency, in response to which the fetus adapts its circulation to preserve oxygen and nutrient supply to the brain (‘brain-sparing'). Currently, little is known about the postnatal course and consequences of this antenatal adaptation of the cerebral circulation. The altered cerebral haemodynamics may persist after birth, which would imply a different approach with regard to cerebral monitoring and clinical management of IUGR preterm neonates than their appropriately grown peers. Few studies are available with regard to this topic, and the small body of evidence shows controversy. This review discusses the cerebral circulatory adaptations of IUGR fetuses and appraises the available literature on their postnatal cerebral circulation with potential clinical consequences.

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Section: Postnatal Cerebral Circulation Following Brain-sparingmentioning

confidence: 71%

Section: Postnatal Cerebral Circulation Following Brain-sparingmentioning

confidence: 99%

Brain-Sparing in Intrauterine Growth Restriction: Considerations for the Neonatologist

2015

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“…The inclusion criteria of this study were as follows: (1) subjects without chromosomal and/or syndromic abnormalities; (2) subjects who were not small for their gestational age (GA); (3) subjects without intraventricular hemorrhage, determined by cranial ultrasonography; (4) subjects who did not show severe metabolic acidosis (pH <7.15) on admission, and (5) subjects who did not undergo a blood transfusion during the study period. Data of 55 (21 term infants and 34 preterm infants) of the 57 appropriate-for-GA infants analyzed in our previous study [14] were included. This study was approved by the Research Ethics Committee of Tokyo Medical University, and written informed consent was obtained from the parents of all infants.…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, it also enables the calculation of cerebral blood volume (CBV) [14,15] and peripheral blood volume (PBV) without performing any invasive procedures.…”

Section: Introductionmentioning

confidence: 99%

Difference in Cerebral and Peripheral Hemodynamics among Term and Preterm Infants during the First Three Days of Life

et al. 2014

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Background: The relationship between cerebral and peripheral hemodynamics during the early postnatal period has not been clarified. Objectives: To evaluate cerebral and peripheral oxygenation and blood volumes between term and preterm infants during the first 3 days of life. Materials and Methods: We performed near-infrared time-resolved spectroscopy on 32 term infants (term group) and 40 preterm infants (preterm group), with an optode placed on their forehead and upper arm. The cerebral blood volume (CBV), peripheral blood volume (PBV), cerebral Hb oxygen saturation (cSO₂) and peripheral Hb oxygen saturation (pSO₂) were measured at 3-6, 12, 24, 48 and 72 h after birth. Results: The CBV in the term group (2.45 ± 0.47 ml/100 g) was significantly higher than that in the preterm group (1.97 ± 0.33 ml/100 g). In contrast to the CBV, the PBV in the preterm group (3.63 ± 0.76 ml/100 g) was significantly higher than that in the term group (3.26 ± 0.56 ml/100 g). In the preterm group, there was a significant positive relationship between the CBVs and PBVs at each time point except at 72 h after birth. Despite the differences in blood volumes, there were no differences in the cSO₂ and pSO₂ between the two groups. Conclusions: The contrasting results in the CBV and PBV between the term and preterm infants might be explained by differences in the maturation of the physiological mechanism to control CBV and PBV.

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“…Our group has previously shown that this brain-sparing effect is postnatally sustained up to 72 h [5,7]. Nevertheless, normalisation - or a trend toward normalisation - of cerebral haemodynamic parameters throughout the first few days of life has also been observed, which could indicate that the cerebral circulatory adaptations following IUGR are transitory [7,16]. Physiological downregulation of compensatory mechanisms may in part explain the observed decline in cerebral oxygenation of our SGA-hsPDA neonates [7].…”

Section: Discussionmentioning

confidence: 96%

Reduction in Cerebral Oxygenation due to Patent Ductus Arteriosus Is Pronounced in Small-for-Gestational-Age Neonates

Cohen

Dix²,

Baerts³

et al. 2016

Neonatology

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Background: A haemodynamically significant patent ductus arteriosus (hsPDA) reduces cerebral oxygenation in appropriate-for-gestational-age (AGA) preterm neonates. Reduced cerebral oxygenation has been associated with brain injury. Preterm small-for-gestational-age (SGA) neonates show higher cerebral oxygenation than AGA peers throughout the first postnatal days. To date, no studies have investigated the effect of hsPDA on cerebral oxygenation in preterm SGA neonates. Objective: We aimed to assess the effect of hsPDA on cerebral oxygenation in preterm SGA neonates compared to AGA peers. We hypothesised that higher baseline cerebral oxygenation would reduce the impact of hsPDA on cerebral oxygenation in preterm SGA neonates. Methods: We monitored regional cerebral oxygen saturation (rScO₂) with near-infrared spectroscopy and calculated the cerebral fractional tissue oxygen extraction (cFTOE) for 72 h after birth. Retrospective analysis compared 36 preterm SGA neonates (birth weight <10th percentile, 18 with hsPDA) to 36 preterm AGA neonates (birth weight 20th to 80th percentile, 18 with hsPDA). Results: In contrast to the other groups, SGA-hsPDA neonates demonstrated a significant fall in rScO₂ [69% (SEM 2.5) at 4-8 h to 61% (2.7) at 68-72 h, p < 0.001] with a concurrent rise in cFTOE [0.26 (0.026) at 4-8 h to 0.34 (0.030) at 68-72 h, p < 0.001]. Conclusions: Contrary to our hypothesis, hsPDA had a significant negative effect on cerebral oxygenation in preterm SGA neonates. Future studies should explore the potential benefits of early screening and treatment for hsPDA on long-term neurodevelopmental outcome in preterm SGA neonates.

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Comparison of changes in cerebral and systemic perfusion between appropriate- and small-for-gestational-age infants during the first three days after birth

Cited by 29 publications

References 30 publications

Brain-Sparing in Intrauterine Growth Restriction: Considerations for the Neonatologist

Brain-Sparing in Intrauterine Growth Restriction: Considerations for the Neonatologist

Difference in Cerebral and Peripheral Hemodynamics among Term and Preterm Infants during the First Three Days of Life

Reduction in Cerebral Oxygenation due to Patent Ductus Arteriosus Is Pronounced in Small-for-Gestational-Age Neonates

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