Abstract
Premature infants are at an increased risk of intraventricular hemorrhage (IVH). The roles of hypotension and hyperemia are still debated. Critical closing pressure (CrCP) is the arterial blood pressure (ABP) at which cerebral blood flow (CBF) ceases. When diastolic ABP is equal to CrCP, CBF occurs only during systole. The difference between diastolic ABP and CrCP is the diastolic closing margin (DCM). We hypothesized that a low DCM was associated with IVH. One hundred eighty-six premature infants, with a gestational age (GA) range of 23–33 weeks, were monitored with umbilical artery catheters and transcranial Doppler insonation of middle cerebral artery flow velocity for 1-h sessions over the first week of life. CrCP was calculated linearly and using an impedance model. A multivariate generalized linear regression model was used to determine associations with severe IVH (grades 3–4). An elevated DCM by either method was associated with IVH (p < 0.0001 for the linear method; p < 0.001 for the impedance model). Lower 5-min Apgar scores, elevated mean CBF velocity, and lower mean ABP were also associated with IVH (p < 0.0001). Elevated DCM, not low DCM, was associated with severe IVH in this cohort.
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References
Aaslid R, Lash S, Bardy G, Gild W, Newell D (2003) Dynamic pressure-flow velocity relationships in the human cerebral circulation. Stroke 34:1645–1649
Al-Aweel I, Pursley D, Rubin L, Sharh B, Weisberger S, Richardson D (2001) Variations in prevalence of hypotension, hypertension, and vasopressor use in NICUs. J Perinatol 21:272–278
Barkovich A, Sargent S (1995) Profound asphyxia in the premature infant: imaging findings. Am J Neuroradiol 16:1837–1846
Cunningham S, Symon A, Elton R, Zhu C, McIntosh N (1999) Intra-arterial blood pressure reference ranges, death and morbidity in very low birthweight infants during the first seven days of life. Early Hum Dev 56:151–165
Del Toro J, Louis PT, Goddard-Finegold J (1991) Cerebrovascular regulation and neonatal brain injury. Pediatr Neurol 7:3–12
Dempsey E, Al Hazzani F, Barrington K (2009) Permissive hypotension in the extremely low birthweight infant with signs of good perfusion. Arch Dis Child Fetal Neonatal Ed 94:F241–F244
Evans N, Kluckow M (1996) Early determinants of right and left ventricular output in ventilated preterm infants. Arch Dis Child Fetal Neonatal Ed 75:F183–F186
Hack M (2006) Young adult outcomes of very-low-birth-weight children. Semin Fetal Neonatal Med 11:127–137
Inder TE, Anderson NJ, Spencer C, Wells S, Volpe JJ (2003) White matter injury in the premature infant: a comparison between serial cranial sonographic and MR findings at term. AJNR Am J Neuroradiol 24:805–809
Jagersberg M, Schaller C, Bostrom J, Schatlo B, Kotowski M, Thees C (2010) Simultaneous bedside assessment of global cerebral blood flow and effective cerebral perfusion pressure in patients with intracranial hypertension. Neurocrit Care 12:225–233
Kluckow M, Evans N (2000) Superior vena cava flow in newborn infants: a novel marker of systemic blood flow. Arch Dis Child Fetal Neonatal Ed 82:F182–F187
Laughon M, Bose C, Allred E, O’Shea TM, Marter LJV, Bednarek F, Leviton A (2007) Factors associated with treatment for hypotension in extremely low gestational age newborns during the first postnatal week. Pediatrics 119:273–280
Nichol J, Girling F, Jerrard W, Claxton E, Burton A (1951)Fundamental instability of the small blood vessels and critical closing pressures in vascular beds. Am J Physiol 164(2):330–344
Panerai R (2003) The critical closing pressure of the cerebral circulation. Med Eng Phys 25:621–632
Varsos GV, Richards H, Kasprowicz M, Budohoski KP, Brady KM, Reinhard M, Avolio A, Smielewski P, Pickard JD, Czosnyka M (2013) Critical closing pressure determined with a model of cerebrovascular impedance. J Cereb Blood Flow Metab 33:235–243
Volpe JJ (1989) Intraventricular hemorrhage in the premature infant current concepts. I. Ann Neurol 25:3–11
Volpe JJ (1989) Intraventricular hemorrhage in the premature infant–current concepts. II. Ann Neurol 25:109–116
Volpe JJ (2001) Neurobiology of periventricular leukomalacia in the premature infant. Pediatr Res 50:553–562
Watkins AM, West CR, Cooke RW (1989) Blood pressure and cerebral haemorrhage and ischaemia in very low birthweight infants. Early Hum Dev 19:103–110
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 gratefully appreciated.
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Rhee, C.J. et al. (2016). The Diastolic Closing Margin Is Associated with Intraventricular Hemorrhage in Premature Infants. 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_30
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DOI: https://doi.org/10.1007/978-3-319-22533-3_30
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