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Updated: Jun 10, 2026
Non-invasive Optical Measurement of Cerebral Metabolism and Hemodynamics in Infants
Published on: March 14, 2013
Changes in cerebral perfusion in extremely LBW infants during the first 72 h after birth
Takeshi Takami1, Daisuke Sunohara, Atsushi Kondo
1Department of Pediatrics, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan. takami@tokyo-med.ac.jp
Insights
Extremely low birth weight (ELBW) infants show significant transitional changes in cerebral oxygenation and perfusion shortly after birth. These changes correlate with evolving cardiac function and output, even in stable infants.
Area of Science:
- Neonatal physiology
- Cardiovascular research
- Cerebral hemodynamics
Background:
- Cerebral perfusion and systemic circulation interplay in extremely low birth weight (ELBW) infants is not well understood.
- Early neonatal period presents critical transitional physiological changes in preterm infants.
Purpose of the Study:
- To investigate cerebral oxygenation and perfusion in relation to systemic circulation in stable ELBW infants.
- To monitor cerebral tissue oxygenation index (TOI) and fractional tissue oxygen extraction (FTOE) alongside cardiac function parameters.
Main Methods:
- Near-infrared spectroscopy (NIRS) used to monitor TOI and FTOE in 16 ELBW infants (gestational age <29 wk) at multiple time points post-birth.
- Echocardiography simultaneously measured left ventricular end-systolic wall stress (ESWS), ejection fraction (LVEF), cardiac output (LVCO), and superior vena cava (SVC) flow.
- Continuous monitoring of mean arterial blood pressure (MABP) was performed.
Main Results:
- Cerebral TOI decreased until 12 hours post-birth and correlated with SVC flow; FTOE increased until 12 hours, then decreased.
- Cardiac parameters showed distinct patterns: ESWS increased then decreased, while LVEF, LVCO, and SVC flow decreased then increased.
- These cerebral and cardiac changes occurred independently of the gradual increase in MABP observed post-birth.
Conclusions:
- Stable ELBW infants exhibit significant transitional changes in cerebral oxygenation and perfusion during the early postnatal period.
- These cerebral hemodynamic shifts appear linked to concurrent alterations in cardiac function and output.
- Findings highlight the dynamic nature of cerebral circulation in ELBW infants and its dependence on cardiovascular adaptation.
Abstract:
Cerebral perfusion and its relation with systemic circulation in extremely LBW (ELBW) infants in the early neonatal period are not well understood. The cerebral tissue oxygenation index (TOI) and cerebral fractional tissue oxygen extraction (FTOE) were monitored in stable 16 ELBW infants (GA <29 wk) using near-infrared spectroscopy (NIRS) at 3-6, 12, 18, 24, 36, 48, and 72 h after birth. The left ventricular end-systolic wall stress (ESWS), left ventricular ejection fraction (LVEF), left ventricular cardiac output (LVCO), and superior vena cava (SVC) flow were also measured simultaneously using echocardiography. The ESWS increased till 18 h and then decreased; LVEF, LVCO, and SVC flow decreased till 12 h and increased thereafter. The TOI decreased till 12 h and correlated with SVC flow; FTOE increased until 12 h and then decreased. These changes in variables of NIRS and echocardiographic measurements contrasted to changes in mean arterial blood pressure (MABP), which showed trends of continuous and gradual increase after birth. We conclude that even stable ELBW infants undergo evident transitional changes in cerebral oxygenation and perfusion in the early postnatal period, which may reflect changes in cardiac function and cardiac output.
