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Monitoring of cerebral haemodynamics in newborn infants
1Department of Neonatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. d.liem@cukz.umcn.nl
Insights
Protecting newborns from brain injuries like cerebral haemorrhage and ischemic injury is crucial. Understanding and stabilizing cerebral haemodynamics, including cerebral blood flow (CBF) and cerebral blood volume (CBV), is key to prevention.
Area of Science:
- Neonatal neurology
- Cerebrovascular physiology
- Perinatal medicine
Background:
- Newborn infants, especially preterm, are susceptible to cerebrovascular injuries such as cerebral haemorrhage and ischemic injury.
- Cerebral haemodynamics, encompassing cerebral blood flow (CBF), velocity, and volume (CBV), are critical in injury pathophysiology.
- Current therapeutic strategies cannot alter vascular anatomy, making prevention of haemodynamic disturbances paramount.
Purpose of the Study:
- To highlight the importance of understanding cerebral haemodynamics in neonatal brain injury.
- To emphasize the need for stable CBF and CBV in preventing injuries.
- To identify areas for future research in neonatal cerebrovascular monitoring and therapy.
Main Methods:
- Review of existing knowledge on neonatal cerebral haemodynamics and autoregulation.
- Discussion of the role of CBF and CBV in cerebrovascular injury.
- Exploration of tissue oxygenation as a potential surrogate for CBF monitoring.
Main Results:
- Disturbances in CBF and CBV significantly contribute to neonatal brain injury.
- Continuous monitoring of CBF and CBV is not yet clinically available.
- Tissue oxygenation offers a potential, though imprecise, surrogate for CBF assessment.
Conclusions:
- Maintaining stable CBF and CBV is essential for preventing neonatal cerebrovascular injuries.
- Further research is needed to develop precise monitoring tools for neonatal CBF and CBV.
- Future efforts should focus on improving understanding of neonatal cerebral autoregulation and implementing 'cerebral perfusion-oriented' therapies.
Abstract:
The most important cerebrovascular injuries in newborn infants, particularly in preterm infants, are cerebral haemorrhage and ischemic injury. The typical cerebral vascular anatomy and the disturbance of cerebral haemodynamics play important roles in the pathophysiology. The term 'cerebral haemodynamics' includes cerebral blood flow (CBF), cerebral blood flow velocity, and cerebral blood volume (CBV). Therapy aimed at changing vascular anatomy is not available. Therefore, prevention of disturbances in CBF and CBV is pivotal. However, continuous monitoring of CBF and CBV is still unavailable for clinical use. Tissue oxygenation may be used as a surrogate for CBF, although precision is still questionable. General knowledge of the regulation of CBF and CBV is important. Although this knowledge is still incomplete, especially regarding autoregulation and the exact role of CBV, it is still useful. Using it even without knowing the exact level of CBF and CBV, it is possible to aim to keep CBF and CBV stable. Future research should focus on development of monitoring tools, gaining more insight in neonatal cerebral autoregulation, and demonstrating clinical benefits of a 'cerebral perfusion-oriented' therapy.
