Abstract
Premature infants are at risk of vascular neurological insults. Hypotension and hypertension are considered injurious, but neither condition is defined with consensus. Critical closing pressure (CrCP) is the arterial blood pressure (ABP) at which cerebral blood flow ceases. CrCP may serve to define subject-specific low or high ABP. Our objective was to quantify CrCP as a function of gestational age (GA). One hundred eighty-six premature infants with a GA range of 23–33 weeks, were monitored with umbilical artery catheters and transcranial Doppler insonation of middle cerebral artery flow velocity (FV) for 1-h sessions over the first week of life. CrCP was calculated using an impedance model derivation with Doppler-based estimations of cerebrovascular resistance and compliance. CrCP increased significantly with GA (r = 0.47; slope = 1.4 mmHg/week gestation), an association that persisted with multivariate analysis (p < 0.001). Higher diastolic ABP and higher GA were associated with increased CrCP (p <0.001 for both). CrCP increases significantly at the end of the second and beginning of the third trimester. The low CrCP observed in premature infants may explain their ability to tolerate low ABP without global cerebral infarct or hemorrhage.
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Acknowledgments
Dr Kaiser was supported by the National Institutes of Health (1K23NS43185, RR20146, and 1R01NS060674) and the University of Arkansas for Medical Sciences (UAMS) Translational Research Institute (1UL1RR029884). The technical assistance of Natalie C. Sikes and Melanie J. Mason, and the support of the UAMS neonatologists, NICU nurses, respiratory therapists, and ultrasound technicians, are greatly appreciated.
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Rhee, C.J. et al. (2016). The Ontogeny of Cerebrovascular Critical Closing Pressure. In: Ang, BT. (eds) Intracranial Pressure and Brain Monitoring XV. Acta Neurochirurgica Supplement, vol 122. Springer, Cham. https://doi.org/10.1007/978-3-319-22533-3_50
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DOI: https://doi.org/10.1007/978-3-319-22533-3_50
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