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Ontogeny of cerebrovascular critical closing pressure

Christopher J Rhee1, Charles D Fraser2, Kathleen Kibler3

  • 1Department of Pediatrics, Baylor College of Medicine, Houston, Texas.

Pediatric Research
|April 1, 2015
PubMed

Insights

Cerebrovascular critical closing pressure (CrCP) increases with gestational age in premature infants. This finding helps explain how very premature infants tolerate low arterial blood pressure without brain injury.

Area of Science:

  • Neonatal neurology
  • Cerebrovascular physiology
  • Developmental pediatrics

Background:

  • Premature infants face risks of vascular neurologic insults.
  • Defining injurious hypotension and hypertension in neonates lacks consensus.
  • Cerebrovascular critical closing pressure (CrCP) marks the arterial blood pressure (ABP) threshold for cessation of cerebral blood flow (CBF).

Purpose of the Study:

  • To determine the developmental trajectory (ontogeny) of CrCP in premature infants.
  • To establish subject-specific thresholds for ABP in neonates.
  • To investigate the relationship between gestational age and CrCP.

Main Methods:

  • Recordings of ABP and middle cerebral artery flow velocity were obtained from 179 premature infants (23-31 wk gestational age) over the first week of life.
  • CrCP was calculated using an impedance-model derivation incorporating cerebrovascular resistance and compliance.
  • Multivariate analysis assessed the association between gestational age and CrCP.

Main Results:

  • The median CrCP was 22 mm Hg (IQR, 19-25 mm Hg).
  • CrCP significantly increased with gestational age (r = 0.6; slope = 1.4 mm Hg/wk gestation).
  • This association remained significant in multivariate analysis (P < 0.0001).

Conclusions:

  • CrCP demonstrates a significant increase from 23 to 31 weeks of gestation.
  • The low CrCP in very premature infants may confer tolerance to low ABP, preventing cerebral infarct or hemorrhage.
  • CrCP may provide a basis for defining individualized ABP management targets in neonates.
Abstract

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