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Cerebral venous volume changes and pressure autoregulation in critically ill infants

Journal of Perinatology volume 40, pages 806–811 (2020)Cite this article

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Abstract

Objective

To determine whether ventilator-related fluctuations in cerebral blood volume (CBV) are associated with cerebral pressure passivity.

Study design

In a prospective study of newborns undergoing positive-pressure ventilation, we calculated coherence between continuous mean arterial pressure (MAP) and cerebral near-infrared spectroscopy hemoglobin difference (HbD). Significant HbD–MAP coherence indicated cerebral pressure passivity. CBV changes were measured as the spectral power of total hemoglobin (SHbT) at the ventilator frequency. A regression model tested whether SHbT predicts cerebral pressure passivity and/or death/brain injury, controlling for birth gestational age and other factors.

Results

We studied 68 subjects with prematurity (n = 19), congenital heart disease (n = 11), and hypoxic–ischemic encephalopathy (n = 38). SHbT, sedative use, and pCO2 were positively associated, and circulating hemoglobin negatively associated, with cerebral pressure passivity (p < 0.001), which was positively associated with brain injury (p < 0.001).

Conclusion

In sick newborns, ventilator-related CBV fluctuations may predispose to cerebral pressure passivity, which may predispose to an adverse neonatal outcome.

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Funding

This study was supported by (1) internal special-purpose funds in the Fetal Medicine Institute at Children’s National and (2) the Clinical and Translational Science Institute at Children’s National (UL1TR000075, 1KL2RR031987-01) and the National Institutes of Health Intellectual and Developmental Disabilities Research Consortium (U54 HD090257).

Author information

Authors and Affiliations

  1. Divisions of Fetal and Transitional Medicine, Children’s National Hospital, Washington, DC, USA

    Vedavalli Govindan, Rathinaswamy Govindan, An N. Massaro, Tareq Al-Shargabi, Nickie N. Andescavage, Marina Metzler, Caitlin Cristante, Christopher Swisher, Daniel Reich & Adre du Plessis

  2. Division of Neonatology, Children’s National Hospital, Washington, DC, USA

    An N. Massaro & Nickie N. Andescavage

  3. Divisions of Diagnostic Imaging and Radiology, Children’s National Hospital, Washington, DC, USA

    Gilbert Vezina & Jonathan Murnick

  4. Biostatistics and Study Methodology, Children’s National Hospital, Washington, DC, USA

    Yunfei Wang

Authors
  1. Vedavalli Govindan
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  2. Rathinaswamy Govindan
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  3. An N. Massaro
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  4. Tareq Al-Shargabi
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  5. Nickie N. Andescavage
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  6. Gilbert Vezina
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  7. Jonathan Murnick
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  8. Yunfei Wang
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  9. Marina Metzler
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  10. Caitlin Cristante
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  11. Christopher Swisher
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  12. Daniel Reich
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  13. Adre du Plessis
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Contributions

VG performed data collection, performed data analysis, and drafted the initial paper. RG and TA-S performed data analysis. ANM and NNA aided in recruitment of subjects and worked to shape the design of the study. GV and JM performed radiological classification of MRI. YW performed statistical analysis and summarized the results. MM, CC, CS, and DR performed data collection. AP and RG conceptualized and designed the study, supervised data analysis. All authors participated in the interpretation of the results, reviewed, and endorsed the final version of the paper.

Corresponding author

Correspondence to Adre du Plessis.

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The authors declare that they have no conflict of interest.

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Govindan, V., Govindan, R., Massaro, A.N. et al. Cerebral venous volume changes and pressure autoregulation in critically ill infants. J Perinatol 40, 806–811 (2020). https://doi.org/10.1038/s41372-020-0626-0

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