Control of cerebral circulation in the high-risk neonate

A knowledge of neonatal cerebrovascular physiology is essential to the understanding of diseases that frequently affect the subsequent development of the newborn brain. Recent observations indicate that the cerebral vessels of the healthy newborn infant, even the very preterm, respond to physiological stimuli in the same manner as in the mature organism. Thus, cerebral blood flow changes with changes in arterial carbon dioxide tension (PaCO2), oxygen concentration (CaO2), or glucose concentration, whereas cerebral blood flow remains constant at minor fluctuations in arterial blood pressure. In pathological states, pressure autoregulation may become impaired, and in severe cases the vessels do not react to chemical or metabolic stimuli. These infants are at high risk for developing cerebral lesion, and they may be candidates for new "brain-protecting regimens."