Effects of Nasal Continuous Positive Airway Pressure on Cerebral Hemodynamics in Preterm Infants

Abstract

Background: To evaluate the effects of pressure levels on cerebral hemodynamics in premature infants receiving nasal continuous positive airway pressure (nCPAP) during the first 3 days of life. Methods: Forty-four preterm infants treated with nCPAP were divided into two groups: very preterm infants [gestational age 1 (GA1), GA < 32 weeks, n = 24] and moderate/late preterm infants (GA2 group, GA 32-37 weeks, n = 20). During monitoring, pressure levels were set at 4→6→8→4 cmH 2 O, and cerebral hemodynamics was assessed by near-infrared spectroscopy (NIRS). Vital signs, peripheral oxygen saturation (SpO 2) and transcutaneous carbon dioxide pressure (TcPCO 2) were simultaneously recorded. Results: Pressures of 4-8 cmH 2 O had no significant influence on cerebral hemodynamics, TcPCO 2 , SpO 2 or other vital signs. The tissue oxygenation index (TOI), the difference between oxygenated hemoglobin (HbO 2) and deoxygenated hemoglobin (HHb) (HbD), and cerebral blood volume (CBV) were all significantly positively correlated with gestational and post-natal age, with fluctuations being greater in the GA1 group. HbD and CBV were also significantly positively correlated with TcPCO 2. Conclusions: No significant differences were observed in cerebral hemodynamics when the nCPAP pressure was set to 4-8 cmH 2 O.

Care Bundle Application Decreases The Frequency and Severity of Intraventricular Hemorrhage in Preterm Neonates: Single Center Study

“…Another risk factor for development of IVH is hypocapnia. Hypocapnia in premature infants is associated with poor neurodevelopmental outcome, including periventricular leukomalacia (PVL), IVH, and cerebral palsy possibly due to cerebral vasoconstriction, decreased CBF, and decreased cerebral oxygen delivery to infants (34)(35)(36). Our study, comparable to another (37) showed significant increase in of IVH in neonates exposed to hypocapnia.…”

Cerebellum and Prematurity: A Complex Interplay Between Disruptive and Dysmaturational Events

“…Additionally, neonatal respiratory distress syndrome, a common condition in premature babies, and its treatment through non-invasive respiratory support, may affect cerebral perfusion. A recent study on nasal continuous positive airway pressure (nCPAP), one of the most frequent ventilation methods used in NICU, analyzed the effects of high pressure on cerebral hemodynamics, stating that cerebral perfusion remains relatively stable when the pressure is set between 4 and 8 cmH 2 O ( Zhou et al, 2020 ).…”