Preservation of single-flash visual evoked potentials at very low cerebral oxygen delivery in preterm infants

Single-flash visual evoked potentials (VEPs) were recorded in 32 preterm infants (mean gestational age: 29 weeks) during extreme physiologic conditions within the first day of life. The VEP configuration was normal in all patients at the onset of the investigation. Hypoxic episodes (PaO2 less than 3 kPa) caused rapid and consistent attenuation of the VEP mostly with an instantaneous recovery after normalization of PaO2. In contrast, VEP amplitude and latency were unaffected during episodes with low cerebral blood flow (4.5 ml/100 gm/min) and correspondingly low oxygen delivery to the brain (1 ml/100 gm/min), severe hypocapnia (PaCO2 1.6 kPa), and severe arterial hypotension (MABP 10 mm Hg), provided that the arterial oxygen tension was greater than 5 kPa. Absence of N1 was observed soon after the development of severe intracranial hemorrhage; however, this abnormality was short in duration. We conclude that the neurons generating VEPs are supported sufficiently during extreme physiologic episodes, except during severe hypoxia. The recovery time may be proportional to the cerebral insult.