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The prediction of estimated cerebral perfusion pressure with trans-systolic time in preterm and term infants

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Abstract

It is important to monitor cerebral perfusion in infants because hypo- and hyperperfusion can contribute to neurological injury. This study aimed to clarify the relationship between trans-systolic time (TST) and critical closing pressure (CrCP) or estimated cerebral perfusion pressure (CPPe) in neonates. Moreover, we aimed to determine the TST values in preterm and term infants with stable cerebral perfusion to clarify normative reference data. This multicentre prospective study included infants with arterial lines admitted to the neonatal intensive care units between December 2021 and August 2023. TST, CrCP, and CPPe were calculated using middle cerebral artery waveforms recorded using transcranial Doppler ultrasonography when clinicians collected arterial blood samples. Three hundred and sixty samples were obtained from 112 infants with a gestational age of 32 (interquartile range, 27–37) weeks and a birth weight of 1481 (956–2355) g. TST was positively correlated with CPPe (r = 0.60, p < 0.001), but not with CrCP (r = 0.08, p = 0.10). The normative reference values of TST in preterm and term infants without samples of hyper- or hypocapnia and/or hyper- or hypotension, which may affect cerebral perfusion, were as follows: ≤ 29 weeks, 0.12 (0.11–0.14) s; 30–36 weeks, 0.14 (0.12–0.15) s; and ≥ 37 weeks, 0.16 (0.14–0.17) s, respectively.

  Conclusion: TST in neonates significantly correlated with CPPe, but not with CrCP. TST may be a good predictor of cerebral perfusion and potentially have wider clinical applications.

What is Known:

• Trans-systolic time (TST) is used in evaluating the effects of increased intracranial pressure on cerebral haemodynamics. However, little is known about the efficacy of TST in predicting neonatal cerebral perfusion pressure.

What is New:

• This study added evidence that TST correlated with estimated cerebral perfusion pressure, but not with critical closing pressure. Additionally, we showed the normative reference values of the TST in preterm and term infants.

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Data availability

No datasets were generated or analysed during the current study.

Abbreviations

ABP:

Arterial blood pressure

CBF:

Cerebral blood flow

CPP:

Cerebral perfusion pressure

CPPe:

Estimated cerebral perfusion pressure

CrCP:

Critical closing pressure

CRIB:

Clinical risk index for babies

FVd:

Diastolic flow velocity

FVs:

Systolic flow velocity

ICP:

Intracranial pressure

MAP:

Mean arterial blood pressure

NICU:

Neonatal intensive care unit

PaCO2 :

Partial pressure of carbon dioxide

PI:

Pulsatility index

RI:

Resistance index

ROC:

Receiver operating characteristic curve

SPECT:

Single-photon emission computed tomography

TCD:

Transcranial Doppler

TST:

Trans-systolic time

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Acknowledgements

We would like to express our appreciation to the nurses and other healthcare professionals for providing and caring for the patients.

Funding

This study was supported by the JSPS KAKENHI (grant number 23K14985).

Author information

Authors and Affiliations

  1. Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi-Hirokoji, Kamigyoku, Kyoto, Japan

    Masashi Zuiki, Daisuke Uda, Madoka Uesugi, Akio Yamano, Hidechika Morimoto, Kanae Hashiguchi, Tatsuji Hasegawa & Tomoko Iehara

  2. Department of Neonatology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan

    Mikito Ohta & Daisuke Kinoshita

  3. Department of Pediatrics, National Hospital Organization Maizuru Medical Center, Kyoto, Japan

    Naoe Fujita & Eisuke Ichise

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  1. Masashi Zuiki
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Contributions

M.Z. designed and performed the experiments. M.O. and E.I. contributed to the data collection. M.Z. wrote the initial draft of the manuscript. N.F., D.U, M.U., A.Y., H.M., K.H., D.K., T.H., T.I. contributed to interpretation and critically reviewed the manuscript. All authors approved the final version of the manuscript and shared accountability for all aspects of the work to ensure that questions related to the accuracy or integrity of any part of the work were appropriately investigated and resolved.

Corresponding author

Correspondence to Masashi Zuiki.

Ethics declarations

Ethics approval

The study protocol was reviewed and approved by the Clinical Ethics Committee of the University Hospital, Kyoto Prefectural University of Medicine (approval number: ERB-C-2426). Research was carried out in line with the principles of the Declaration of Helsinki.

Consent to participate

This study was designed and received ethical approval to use opt-out consent for all eligible infants born in the participating units. The parents of eligible infants were offered the opportunity to opt out of their infants’ data for inclusion in this study.

Competing interests

The authors declare no competing interests.

STROBE statement

The authors have read the STROBE statement checklist of items, and the manuscript was prepared in accordance with this statement and checklist.

Additional information

Communicated by Daniele De Luca

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Zuiki, M., Ohta, M., Fujita, N. et al. The prediction of estimated cerebral perfusion pressure with trans-systolic time in preterm and term infants. Eur J Pediatr (2024). https://doi.org/10.1007/s00431-024-05511-9

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