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Relationship of cerebral blood volume with arterial and venous flow velocities in extremely low-birth-weight infants

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Abstract

Unstable cerebral blood flow is theorised to contribute to the occurrence of intraventricular haemorrhage (IVH) in extremely low-birth-weight infants (ELBWIs), which can be caused by increased arterial flow, increased venous pressure, and impaired autoregulation of brain vasculature. As a preliminary step to investigate such instability, we aimed to check for correlations of cerebral blood volume (CBV), as measured using near-infrared spectroscopy, with the flow velocities of the anterior cerebral artery (ACA) and internal cerebral vein (ICV), as measured using Doppler ultrasonography. Data were retrospectively analysed from 30 ELBWIs uncomplicated by symptomatic patent ductus arteriosus, which can influence ACA velocity, and severe IVH (grade ≥ 3), which can influence ICV velocity and CBV. The correlation between tissue oxygen saturation (StO2) and mean blood pressure was also analysed as an index of autoregulation. CBV was not associated with ACA velocity; however, it was significantly correlated with ICV velocity (Pearson R = 0.59 [95% confidence interval: 0.29–0.78], P = 0.00061). No correlation between StO2 and mean blood pressure was observed, implying that autoregulation was not impaired.

    Conclusion: Although our findings are based on the premise that cerebral autoregulation was unimpaired in the ELBWIs without complications, the same result cannot be directly applied to severe IVH cases. However, our results may aid future research on IVH prediction by investigating the changes in CBV when severe IVH occurs during ICV velocity fluctuation.

What is Known:

• The pathogenesis of IVH includes unstable cerebral blood flow affected by increased arterial flow, increased venous pressure, and impaired cerebral autoregulation.

• The approaches that can predict IVH are under discussion.

What is New:

• ACA velocity is not associated with CBV, but ICV velocity is significantly correlated with CBV.

• CBV measured using NIRS may be useful in future research on IVH prediction.

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Availability of data and material

All data are within manuscript; data are available upon reasonable request to the corresponding author.

Abbreviations

ACA:

Anterior cerebral artery

AGA:

Appropriate for gestational age

CBF:

Cerebral blood flow

CBV:

Cerebral blood volume

EDV:

End-diastolic velocity

ELBWI:

Extremely low-birth-weight infant

HHb:

Deoxyhaemoglobin

ICV:

Internal cerebral vein

IVH:

Intraventricular haemorrhage

NIRS:

Near-infrared spectroscopy

O2Hb:

Oxyhaemoglobin

PDA:

Patent ductus arteriosus

PSV:

Peak systolic velocity

RI:

Resistance index

SGA:

Small for gestational age

StO2 :

Tissue oxygen saturation

tHb:

Total haemoglobin

TRS:

Time-resolved spectroscopy

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Funding

This work was supported by a research grant from the Saitama Children’s Medical Center (2022-A5).

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Authors and Affiliations

  1. Division of Neonatology, Department of Maternal and Perinatal Center, Saitama Children’s Medical Center, 1-2 Shintoshin, Chuo, Saitama, 330-8777, Japan

    Toshiyuki Imanishi, Wakako Sumiya, Chika Kanno, Masayuki Kanno, Ken Kawabata & Masaki Shimizu

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  1. Toshiyuki Imanishi
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  2. Wakako Sumiya
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  4. Masayuki Kanno
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Toshiyuki Imanishi, Wakako Sumiya, Chika Kanno, Masayuki Kanno, Ken Kawabata, and Masaki Shimizu. The first draft of the manuscript was written by Toshiyuki Imanishi, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Toshiyuki Imanishi.

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Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki and approved by the Institutional Research Ethics Board of Saitama Children’s Medical Center.

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Informed consent was obtained from the families of all patients included in the study.

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Informed consent was obtained from the families of all patients included in the study.

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The authors have no relevant financial or non-financial interests to disclose.

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Communicated by Daniele De Luca.

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Imanishi, T., Sumiya, W., Kanno, C. et al. Relationship of cerebral blood volume with arterial and venous flow velocities in extremely low-birth-weight infants. Eur J Pediatr 182, 2821–2832 (2023). https://doi.org/10.1007/s00431-023-04969-3

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