Abstract
Background
Changes in systemic and cerebral hemodynamics in preterm infants during early transitional circulation are complex and may differ between infants with or without intraventricular hemorrhage (IVH).
Method
In total, 43 infants born at median (range) 25 + 5 (23 + 3–31) had continuous near-infrared spectroscopy (NIRS) monitoring of tissue oxygenation index (TOI) and cerebrovascular reactivity within the first 48 h of life. Measurements of left and right cardiac outputs (LVO, RVO) and patent ductus arteriosus (PDA) were collected at 6, 12, 24, and 48 h of life.
Results
LVO increased within the first 48 h in the IVH (P = 0.007) and no-IVH (P < 0.001) groups. The pattern of change in LVO and RVO was not different between these two groups. TOI was lower in the IVH (P < 0.001) group. A positive correlation between TOI and LVO (P = 0.003) and a negative correlation between the tissue oxygen reactivity index (TOx) and LVO (P = 0.04) were observed at 24 h of life in the IVH group. PDA diameter was not different between IVH groups at any time interval.
Conclusion
Cerebral oxygenation was lower and cerebrovascular reactivity was passive to systemic blood flow at 24 h in infants who developed an IVH.
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References
Meek, J. H. et al. Low cerebral blood flow is a risk factor for severe intraventricular haemorrhage. Arch. Dis. Child Fetal Neonatal Ed. 81, F15–F18 (1999).
Kluckow, M. & Evans, N. Low superior vena cava flow and intraventricular haemorrhage in preterm infants. Arch. Dis. Child Fetal Neonatal Ed. 82, F188–F194 (2000).
Noori, S. et al. Changes in cardiac function and cerebral blood flow in relation to peri/intraventricular hemorrhage in extremely preterm infants. J. Pediatr. 164, 264–270 (2014). e261-263.
Soul, J. S. et al. Fluctuating pressure-passivity is common in the cerebral circulation of sick premature infants. Pediatr. Res. 61, 467–473 (2007).
Pryds, O. et al. Heterogeneity of cerebral vasoreactivity in preterm infants supported by mechanical ventilation. J. Pediatr. 115, 638–645 (1989).
Evans, N. & Kluckow, M. Early determinants of right and left ventricular output in ventilated preterm infants. Arch. Dis. Child Fetal Neonatal Ed. 74, F88–F94 (1996).
Wong, F. Y. et al. Impaired autoregulation in preterm infants identified by using spatially resolved spectroscopy. Pediatrics 121, e604–e611 (2008).
da Costa, C. S. et al. Monitoring of cerebrovascular reactivity for determination of optimal blood pressure in preterm infants. J. Pediatr. 167, 86–91 (2015).
da Costa, C. S. et al. Optimal mean arterial blood pressure in extremely preterm infants within the first 24 h of life. J. Pediatr. 203, 242–248 (2018).
Beker, F. et al. Echocardiographic assessment of left ventricular outflow tract diameter in preterm infants. Austral. J. Ultrasound Med. 17, 146–149 (2014).
Mandelbaum-Isken, V. H. & Linderkamp, O. Cardiac output by pulsed Doppler in neonates using the apical window. Pediatr. Cardiol. 12, 13–16 (1991).
Su, B. H. et al. Echocardiographic assessment of patent ductus arteriosus shunt flow pattern in premature infants. Arch. Dis. Child Fetal Neonatal Ed. 77, F36–F40 (1997).
Kluckow, M. & Evans, N. Early echocardiographic prediction of symptomatic patent ductus arteriosus in preterm infants undergoing mechanical ventilation. J. Pediatr. 127, 774–779 (1995).
El Hajjar, M. et al. Severity of the ductal shunt: a comparison of different markers. Arch. Dis. Child Fetal Neonatal Ed. 90, F419–F422 (2005).
Groves, A. M., Kuschel, C. A., Knight, D. B. & Skinner, J. R. Does retrograde diastolic flow in the descending aorta signify impaired systemic perfusion in preterm infants? Pediatr. Res. 63, 89–94 (2008).
Papile, L. A. et al. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1500 gm. J. Pediatr. 92, 529–534 (1978).
Smielewski, P. et al. ICM + : software for on-line analysis of bedside monitoring data after severe head trauma. Acta Neurochir. Suppl. 95, 43–49 (2005).
Mitra, S. et al. Heart rate passivity of cerebral tissue oxygenation is associated with predictors of poor outcome in preterm infants. Acta Paediatr. 103, e374–e382 (2014).
Brady, K. M. et al. Continuous time-domain analysis of cerebrovascular autoregulation using near-infrared spectroscopy. Stroke 38, 2818–2825 (2007).
Walther, F. J. et al. Pulsed Doppler determinations of cardiac output in neonates: normal standards for clinical use. Pediatrics 76, 829–833 (1985).
Alderliesten, T. et al. Cerebral oxygenation, extraction, and autoregulation in very preterm infants who develop peri-intraventricular hemorrhage. J. Pediatr. 162, 698–704 e692 (2013).
Kissack, C. M. et al. Cerebral fractional oxygen extraction in very low birth weight infants is high when there is low left ventricular output and hypocarbia but is unaffected by hypotension. Pediatr. Res. 55, 400–405 (2004).
Victor, S. et al. The relationship between cardiac output, cerebral electrical activity, cerebral fractional oxygen extraction and peripheral blood flow in premature newborn infants. Pediatr. Res. 60, 456–460 (2006).
Sirc, J., Dempsey, E. M. & Miletin, J. Cerebral tissue oxygenation index, cardiac output and superior vena cava flow in infants with birth weight less than 1250 grams in the first 48 h of life. Early Hum. Dev. 89, 449–452 (2013).
Takami, T. et al. Changes in cerebral perfusion in extremely LBW infants during the first 72 h after birth. Pediatr. Res. 68, 435–439 (2010).
Moran, M. et al. Cerebral tissue oxygenation index and superior vena cava blood flow in the very low birth weight infant. Acta Paediatr. 98, 43–46 (2009).
Williams, L. R. & Leggett, R. W. Reference values for resting blood flow to organs of man. Clin. Phys. Physiol. Meas. 10, 187–217 (1989).
Levine, B. D. et al. Cerebral versus systemic hemodynamics during graded orthostatic stress in humans. Circulation 90, 298–306 (1994).
Ogoh, S. et al. The effect of changes in cardiac output on middle cerebral artery mean blood velocity at rest and during exercise. J. Physiol. 569, 697–704 (2005).
Choi, B. R. et al. Factors associated with decreased cerebral blood flow in congestive heart failure secondary to idiopathic dilated cardiomyopathy. Am. J. Cardiol. 97, 1365–1369 (2006).
Berre, J. et al. Dobutamine increases cerebral blood flow velocity and jugular bulb hemoglobin saturation in septic patients. Crit. Care Med. 25, 392–398 (1997).
Meng, L. et al. Cardiac output and cerebral blood flow: the integrated regulation of brain perfusion in adult humans. Anesthesiology 123, 1198–1208 (2015).
Cencetti, S. et al. Autonomic control of the cerebral circulation during normal and impaired peripheral circulatory control. Heart 82, 365–372 (1999).
Kusaka, T. et al. Cerebral distribution of cardiac output in newborn infants. Arch. Dis. Child Fetal Neonatal Ed. 90, F77–F78 (2005).
Noori S. S. T., Seri I. Neonatology Questions and Controversies: Hemodynamics and Cardiology (ed. Kleinman C. S. I.) 3–22 (Elsevier Sauders, Philadelphia, USA, 2012).
Evans, N. & Kluckow, M. Early ductal shunting and intraventricular haemorrhage in ventilated preterm infants. Arch. Dis. Child Fetal Neonatal Ed. 75, F183–F186 (1996).
Jim, W. T. et al. Cerebral hemodynamic change and intraventricular hemorrhage in very low birth weight infants with patent ductus arteriosus. Ultrasound Med. Biol. 31, 197–202 (2005).
Osborn, D. A., Evans, N. & Kluckow, M. Left ventricular contractility in extremely premature infants in the first day and response to inotropes. Pediatr. Res. 61, 335–340 (2007).
Ballestero, Y. et al. Measurement of cardiac output in children by bioreactance. Pediatr. Cardiol. 32, 469–472 (2011).
Weisz, D. E. et al. Non-invasive cardiac output monitoring in neonates using bioreactance: a comparison with echocardiography. Neonatology 102, 61–67 (2012).
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SPARKS charity (11CUH02); Cambridge Trust and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) (PhD scholarship to Dr. Sortica da Costa/9418–11–3).
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Substantial contributions to conception and design of the research work: C.S.da.C., Z.M., M.C., P.S. and T.A. Acquisition of data or analysis, and interpretation of data: C.S.da.C., D.C., I.Ng., Z.M. and W.K. Drafting the article: C.S.da.C. Revising the article critically for important intellectual content: D.C., Z.M., I.Ng., W.K., M.C., P.S. and T.A. Final approval of the version to be published: all authors.
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The ICM+® software (ICM+; www.neurosurg.cam.ac.uk/icmplus) used for data monitoring and analysis is licensed by the Cambridge Enterprise Limited (University of Cambridge). Dr. Peter Smielewski and Professor Marek Czosnyka have an interest in a fraction of the licensing fee. The other authors have no conflicts of interests to disclosure.
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Sortica da Costa, C., Cardim, D., Molnar, Z. et al. Changes in hemodynamics, cerebral oxygenation and cerebrovascular reactivity during the early transitional circulation in preterm infants. Pediatr Res 86, 247–253 (2019). https://doi.org/10.1038/s41390-019-0410-z
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DOI: https://doi.org/10.1038/s41390-019-0410-z
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