Abstract
The sick newborn infant is vulnerable to brain injury and impaired cerebral autoregulation is thought to contribute to this. Coherent averaging is a method of measuring the dynamic cerebral autoregulatory response that is particularly suitable for neonates. We used this method in combination with a measure of the gradient of the cerebral blood flow velocity (CBFV) response following transient blood pressure (BP) peaks to study dynamic autoregulation in infants undergoing intensive care. Term and preterm infants at high risk of neurologic injury were compared with a control group of infants, also undergoing intensive care. Simultaneous video-EEG, CBFV (using transcranial Doppler), and arterial blood pressure measurements were obtained intermittently during a study period of at least 2 h. Cerebral autoregulatory response curves were constructed for high risk and control groups. Intact cerebral autoregulation produces a characteristic response consisting of a brief period when CBFV follows arterial blood pressure but quickly returns to baseline value. An impaired autoregulatory response shows CBFV mirroring the arterial blood pressure curve closely. Thirteen high-risk infants, who also had seizures (10 term and 3 preterm) and 12 control infants (6 term and 6 preterm) were studied. Autoregulation was absent in high-risk term and preterm infants. It was also absent in preterm control infants. Term, neurologically healthy infants undergoing intensive care have an intact autoregulatory response. The constant passive response seen in high-risk infants may reflect the severity of the underlying neurologic disease.
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Abbreviations
- ABP:
-
arterial blood pressure
- CBF:
-
cerebral blood flow
- CBFV:
-
cerebral blood flow velocity
- HIE:
-
hypoxic ischemic encephalopathy
References
Milligan DW 1980 Failure of autoregulation and intraventricular haemorrhage in preterm infants. Lancet 1: 896–898
Jorch G, Jorch N 1987 Failure of autoregulation of cerebral blood flow in neonates studied by pulsed Doppler ultrasound of the internal carotid artery. Eur J Pediatr 146: 468–472
Paulson OB, Strandgaard S, Edvinson L 1990 Cerebral autoregulation. Cerebrovasc Brain Metab Rev 2: 161–192
Rennie JM 1998 Autoregulation of cerebral blood flow. Lancet 26: 2023
Panerai R 1998 Assessment of cerebral pressure autoregulation in humans—a review of measurement methods. Physiol Meas 19: 305–338
Aaslid R, Lindegaard KF, Sorteberg W, Nornes H 1989 Cerebral autoregulation dynamics in humans. Stroke 20: 45–52
Panerai RB, Kelsall AWR, Rennie JM, Evans DH 1995 Cerebral autoregulation dynamics in premature newborns. Stroke 26: 74–80
Boylan GB, Panerai RB, Rennie JM, Evans DH, Rabe-Hesketh S, Binnie CD 1999 Cerebral blood flow velocity during neonatal seizures. Arch Dis Child 80: F105–F110
Borch K, Pryds O, Holm S, Lou H, Greisen G 1998 Regional cerebral blood flow during seizures in neonates. J Pediatr 132: 431–435
Mizrahi EM, Kellaway P 1987 Characterization and classification of neonatal seizures. Neurology 37: 1837–1844
Clancy RR, Legido A, Lewis D 1988 Occult neonatal seizures. Epilepsia 29: 256–261
Weiner SP, Painter MJ, Geva D, Guthrie RD, Scher M 1991 Neonatal seizures: electroclinical dissociation. Pediatr Neurol 7: 363–368
Holmes GL, Gairsa JL, Chevassus-Au-Louis N, Yehezkel B 1998 Consequences of neonatal seizures in the rat: morphological and behavioural effects. Ann Neurol 44: 845–857
Evans DH, Schlindwein FS, Levene MI 1989 An automatic system for capturing and processing ultrasonic Doppler signals and blood pressure signals. Clin Phys Physiol Meas 10: 241–251
Amiel-Tison C, Grenier A 1986 Neurological Assessment in the First Year of Life. Oxford University Press, New York, pp 1–132
Griffiths R 1986 The Abilities of Babies. University of London Press, London, pp 1–234
Clancy R, Legido A 1987 The exact ictal and interictal duration of electroencephalographic neonatal seizures. Epilepsia 28: 537–541
Harter HL 1980 Early History of Multiple Comparison Tests. In: Krishnaiah PR (ed) Handbook of Statistics 1: Analysis of Variance. North-Holland Publishing Company, New York, pp 619–621
Anthony MY, Evans DH, Levene MI 1993 Neonatal cerebral blood flow velocity responses to changes in posture. Arch Dis Child 69: 304–308
Lou HC, Lassen NA, Friis-Hansen B 1979 Impaired autoregulation of cerebral blood flow in the distressed newborn infant. J Pediatr 94: 118–121
Tyszczuk L, Meek J, Elwell C, Wyatt JS 1998 Cerebral blood flow is independent of mean arterial blood pressure in preterm infants undergoing intensive care. Pediatrics 102: 337–341
Pryds O, Griesen G, Lou H, Friis-Hansen B 1990 Vasoparalysis associated with brain damage in asphyxiated term infants. J Pediatr 117: 119–124
Acknowledgements
The authors thank the nursing and medical staff at the NICU, Kings College Hospital. We also thank all parents who allowed their children to take part in the study.
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Boylan, G., Young, K., Panerai, R. et al. Dynamic Cerebral Autoregulation in Sick Newborn Infants. Pediatr Res 48, 12–17 (2000). https://doi.org/10.1203/00006450-200007000-00005
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DOI: https://doi.org/10.1203/00006450-200007000-00005
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