Impaired autoregulation of cerebral blood flow in the distressed newborn infant

Lou, Hans C.; Lassen, Niels A.; Friis-Hansen, B

doi:10.1016/s0022-3476(79)80373-x

Cited by 641 publications

(239 citation statements)

References 13 publications

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“…[26][27][28] Acute changes in MABP may also affect CBF, especially if premature infants have impaired cerebral autoregulation. 29,33 In contrast to Perlman et al, 1 in our infant sample, MABP did not significantly influence mean CBFv, suggesting that cerebral autoregulation was probably intact in a majority of our sample group. We were not surprised by this observation since only normotensive VLBW infants with normal cranial ultrasound findings were enrolled in our study, and previous investigations have reported similar results.…”

Section: Discussioncontrasting

confidence: 95%

Tracheal suctioning is associated with prolonged disturbances of cerebral hemodynamics in very low birth weight infants

2007

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Objectives: Examining the effects of tracheal suctioning on cerebral hemodynamics of normotensive ventilated very low birth weight (VLBW) infants with normal cranial ultrasounds; determining the factor(s) influencing changes in mean cerebral blood flow velocity (CBFv) after suctioning.Methods: Seventy-three VLBW infants had continuous monitoring of mean arterial blood pressure (MABP), PaCO 2 , PaO 2 and mean CBFv before, during, and after 202 suctioning sessions during the first week of life. Peak (or nadir) and relative changes of the four variables for 45 min after suctioning were calculated. Multiple linear regression was used to determine the factor(s) influencing changes in mean CBFv after suctioning.Result: Birth weight was 928 ± 244 g; gestational age was 27.0 ± 2.0 weeks. Mean CBFv increased to 31.0 ± 26.4% after suctioning and remained elevated for 25 min. PaCO 2 was highly associated with mean CBFv (P<0.001), whereas MABP and PaO 2 were not. Conclusion:We observed prolonged increases of mean CBFv following suctioning in ventilated VLBW infants that were previously unrecognized. This is concerning since disturbances of CBF may be associated with subsequent brain injury.

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Section: Discussioncontrasting

confidence: 95%

Tracheal suctioning is associated with prolonged disturbances of cerebral hemodynamics in very low birth weight infants

2007

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“…9,[12][13][14] Using linear mixed models with random effects, individual changes in MCBFV were related to MBP changes; this finding is consistent with impaired autoregulation of cerebral circulation or a pressure-passive pattern in sick preterm infants as reported by other investigators. 4,6,13 Furthermore, we found that associated changes in MCBFV for each unit change in MBP were greater in infants who demonstrated an increase in PACO 2 . These findings suggest that increases in PACO 2 may aggravate cerebral hemodynamic alterations in those with already impaired cerebral autoregulation.…”

Section: Discussionmentioning

confidence: 53%

“…2 Fluctuations in cerebral blood flow have been implicated in the pathogenesis of IVH, 3 especially in sick preterm infants who reportedly have impaired cerebral blood flow autoregulation. 4,5 Elimination of fluctuation in cerebral blood flow has been associated with a lower incidence of IVH. 6 In an attempt to relate cerebral blood flow changes to surfactant administration, the influence of surfactant on cerebral blood flow velocity (CBFV) was studied by several investigators but with conflicting results.…”

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confidence: 99%

Cerebral Blood Flow Velocity Changes After Bovine Natural Surfactant Instillation

et al. 2000

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OBJECTIVE:To determine the effects of bovine natural surfactant (beractant) instillation on cerebral hemodynamics in preterm infants with respiratory distress syndrome (RDS). STUDY DESIGN:Preterm infants who required surfactant for RDS were enrolled. Cerebral blood flow velocity (CBFV) waveforms from the pericallosal artery were analyzed by pulsed Doppler ultrasonography with the anterior fontanel serving as an acoustic window. CBFV was measured before and at 5, 10, 20, and 30 minutes after the first dose of a bolus instillation of surfactant in four aliquots. Simultaneously with CBFV measurements, mean blood pressure (MBP), heart rate, and ventilator settings were recorded. pH, PACO 2 , and PAO 2 before and at 30 minutes after surfactant administration were also determined. RESULTS:The 30 enrolled preterm infants had a mean birth weight of 973 gm (513 to 1996 gm) and a mean gestational age of 27 weeks (23 to 33 weeks). Mean postnatal age at surfactant administration was 4.7 Ϯ 2.7 hours. There were no significant changes in pH and PACO 2 before and at 30 minutes after surfactant (before surfactant: mean pH of 7.29 Ϯ 0.07 and mean PACO 2 of 44.4 Ϯ 7.1 torr; after surfactant: mean pH of 7.31 Ϯ 0.07 and mean PACO 2 of 42.7 Ϯ 8.3 torr). PAO 2 increased significantly from a pre-surfactant mean of 83 torr to 130 torr at 30 minutes after surfactant (p Ͻ 0.05), with no significant changes in mean airway pressure. There were no significant changes in MBP, heart rate, mean CBFV, peak systolic flow velocity, and diastolic flow velocity before and after surfactant instillation regardless of gestational age. Individ--ual changes in mean CBFV were related to MBP changes (p Ͻ 0.001, linear mixed models with random effects).

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“…Lou et al reported on 19 infants with respiratory distress syndrome (RDS) in combination with perinatal asphyxia showing a linear relationship between CBF (measured by the 133 Xe technique) and systolic ABP within the first hours after birth [24]. Milligan et al reported on five preterm infants with increasing CBF values (measured by jugular venous occlusion plethysmography) after receiving either whole blood or blood product transfusions resulting in increased mean arterial blood pressure (MABP) levels of 5-14 mmHg on days 1 till 4 after birth.…”

Section: Cerebrovascular Autoregulation In Preterm Infantsmentioning

confidence: 99%

Measuring cerebrovascular autoregulation in preterm infants using near-infrared spectroscopy: an overview of the literature

Kooi¹,

Verhagen

Elting

et al. 2017

Expert Review of Neurotherapeutics

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(2017) Measuring cerebrovascular autoregulation in preterm infants using near-infrared spectroscopy: an overview of the literature, Expert Review of Neurotherapeutics, 17:8, 801-818, DOI: 10.1080/14737175.2017 Introduction:The preterm born infant's ability to regulate its cerebral blood flow (CBF) is crucial in preventing secondary ischemic and hemorrhagic damage in the developing brain. The relationship between arterial blood pressure (ABP) and CBF estimates, such as regional cerebral oxygenation as measured by near-infrared spectroscopy (NIRS), is an attractive option for continuous non-invasive assessment of cerebrovascular autoregulation. Areas covered: The authors performed a literature search to provide an overview of the current literature on various current clinical practices and methods to measure cerebrovascular autoregulation in the preterm infant by NIRS. The authors focused on various aspects: Characteristics of patient cohorts, surrogate measures for cerebral perfusion pressure, NIRS devices and their accompanying parameters, definitions for impaired cerebrovascular autoregulation, methods of measurements and clinical implications. Expert commentary: Autoregulation research in preterm infants has reported many methods for measuring autoregulation using different mathematical models, signal processing and data requirements. At present, it remains unclear which NIRS signals and algorithms should be used that result in the most accurate and clinically relevant assessment of cerebrovascular autoregulation. Future studies should focus on optimizing strategies for cerebrovascular autoregulation assessment in preterm infants in order to develop autoregulation-based cerebral perfusion treatment strategies. ARTICLE HISTORY

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Impaired autoregulation of cerebral blood flow in the distressed newborn infant

Cited by 641 publications

References 13 publications

Tracheal suctioning is associated with prolonged disturbances of cerebral hemodynamics in very low birth weight infants

Tracheal suctioning is associated with prolonged disturbances of cerebral hemodynamics in very low birth weight infants

Cerebral Blood Flow Velocity Changes After Bovine Natural Surfactant Instillation

Measuring cerebrovascular autoregulation in preterm infants using near-infrared spectroscopy: an overview of the literature

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