Abstract
Background
Post-hemorrhagic ventricular dilatation (PHVD) is predictive of mortality and morbidity among very-low-birth-weight preterm infants. Impaired cerebral blood flow (CBF) due to elevated intracranial pressure (ICP) is believed to be a contributing factor.
Methods
A hyperspectral near-infrared spectroscopy (NIRS) method of measuring CBF and the cerebral metabolic rate of oxygen (CMRO2) was used to investigate perfusion and metabolism changes in patients receiving a ventricular tap (VT) based on clinical management. To improve measurement accuracy, the spectral analysis was modified to account for compression of the cortical mantle caused by PHVD and the possible presence of blood breakdown products.
Results
From nine patients (27 VTs), a significant CBF increase was measured (15.6%) following VT (14.6±4.2 to 16.9±6.6 ml/100 g/min), but with no corresponding change in CMRO2 (1.02±0.41 ml O2/100 g/min). Post-VT CBF was in good agreement with a control group of 13 patients with patent ductus arteriosus but no major cerebral pathology (16.5±7.7 ml/100 g/min), whereas tissue oxygen saturation (StO2) was significantly lower (58.9±12.1% vs. 70.5±9.1% for controls).
Conclusion
CBF was impeded in PHVD infants requiring a clinical intervention, but the effect is not large enough to alter CMRO2.
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Acknowledgements
We thank the families of the newborns who consented to participate in the study.
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This work was supported by operating grants from the Canadian Institutes of Health Research. K.S.L. was supported by a personnel award from the Heart and Stoke Foundation, Ontario Provincial Office.
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McLachlan, P., Kishimoto, J., Diop, M. et al. Investigating the effects of cerebrospinal fluid removal on cerebral blood flow and oxidative metabolism in infants with post-hemorrhagic ventricular dilatation. Pediatr Res 82, 634–641 (2017). https://doi.org/10.1038/pr.2017.131
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DOI: https://doi.org/10.1038/pr.2017.131
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