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Modeling Posthemorrhagic Hydrocephalus of Prematurity in Rats
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Elevated cerebral pressure passivity is associated with prematurity-related intracranial hemorrhage

Heather O'Leary1, Matthew C Gregas, Catherine Limperopoulos

  • 1Fetal-Neonatal Neurology Research Group, Department of Neurology, and Children's Hospital Boston, Massachusetts 02115, USA.

Pediatrics
|July 1, 2009
PubMed

Insights

Cerebral pressure passivity, measured by MAP-HbD gain, is linked to germinal matrix/intraventricular hemorrhage (GM/IVH) in premature infants. This finding may help predict and prevent brain bleeds in vulnerable newborns.

Area of Science:

  • Neonatal Neurology
  • Cerebrovascular Physiology
  • Medical Monitoring

Background:

  • Cerebral pressure passivity is common in premature infants and a risk factor for germinal matrix/intraventricular hemorrhage (GM/IVH).
  • GM/IVH can lead to serious neurological consequences in neonates.

Purpose of the Study:

  • To investigate the association between the magnitude of cerebral pressure passivity and the incidence of GM/IVH in premature infants.
  • To evaluate a novel cerebrovascular monitoring technique for quantifying cerebral pressure passivity.

Main Methods:

  • Enrolled infants <32 weeks gestational age with indwelling mean arterial pressure (MAP) monitoring.
  • Recorded continuous MAP and cerebral near-infrared spectroscopy hemoglobin difference (HbD) signals.
  • Analyzed MAP-HbD signals in 3 frequency bands to calculate MAP-HbD gain.
  • Developed a logistic regression model using MAP-HbD gain and clinical variables to predict cranial ultrasound abnormalities.

Main Results:

  • In 88 infants, 37% showed GM/IVH on early cranial ultrasound.
  • Low-frequency MAP-HbD gain (highest quartile) was significantly associated with early GM/IVH.
  • Gestational age and MAP-HbD gain were the most parsimonious predictors of early GM/IVH.

Conclusions:

  • A novel technique quantifies cerebral pressure passivity in premature infants using MAP-HbD gain.
  • High MAP-HbD gain is significantly associated with GM/IVH.
  • Further research is needed to establish the precise temporal and causal relationship between MAP-HbD gain and GM/IVH.
Abstract

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