Abstract
Perinatal distress in the preterm neonate, and the consequent loss of cerebrovascular autoregulation, has been implicated in the pathogenesis of neonatal cerebral lesions. A component of this distress is thought to be hypotension. We examined the autoregulatory capacity of hypotensive and normotensive infants using the 133Xe technique to measure cerebral blood flow. Global CBF was measured during only normotension in 5 infants, and during both hypotension and normotension in 11 infants. All the infants were ventilated and blood pressure was measured using an intra-arterial catheter. Fourteen CBF measurements were made on the normotensive infants. Forty-seven CBF measurements were made on the hypotensive infants, 34 measurements during hypotension and 13 during normotension. The global CBF of the normotensive and hypotensive infants were 13.3 and 13.6 mL/100 g/min, respectively. The mean arterial blood pressure (MABP)-CBF reactivity (95% CI) of the normotensive and hypotensive infants were 1.9% (−0.8% to 4.7%)/mm Hg and 1.9% (0.8% to 3.0%)/mm Hg, respectively. The CO2-CBF reactivity (95%CI) of the normotensive and hypotensive infants was 11.1% (6.8% to 15.5%)/KPa ΔPaCO2 and 4.1% (−5.0% to 14.1%)/KPa ΔPaCO2. The implications of these calculated CBF reactivities is that normotensive infants may have intact autoregulation but with a diminished response to fluctuations in PaCO2. The hypotensive infants appear to have attenuated or absent autoregulation with little or no response in CBF to changes in PaCO2.
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Abbreviations
- CBF:
-
global cerebral blood flow
- CBFv:
-
cerebral blood flow velocity
- MABP:
-
mean arterial blood pressure
- MAP15:
-
MABP averaged over 15 min
- PaCO2:
-
partial pressure of carbon dioxide
- PDA:
-
patent ductus arteriosus
- VLBW:
-
very low birthweight
- 95%:
-
CI 95% confidence interval
- 133Xe:
-
133Xenon radionuclide
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Acknowledgements
We would like to thank the Special Trustees of the General Infirmary at Leeds for funding the study and Professor Gorm Greisen for helpful advice during the course of the study.
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Jayasinghe, D., Gill, A. & Levene, M. CBF Reactivity in Hypotensive and Normotensive Preterm Infants. Pediatr Res 54, 848–853 (2003). https://doi.org/10.1203/01.PDR.0000088071.30873.DA
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DOI: https://doi.org/10.1203/01.PDR.0000088071.30873.DA
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