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Elevated Diastolic Closing Margin Is Associated with Intraventricular Hemorrhage in Premature Infants
Christopher J Rhee1, Jeffrey R Kaiser2, Danielle R Rios1
1Section of Neonatology, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, TX.
Insights
Elevated diastolic closing margin (DCM), a measure of cerebral perfusion, is linked to severe intraventricular hemorrhage (IVH) in premature infants. Higher DCM increases the risk of developing IVH.
Area of Science:
- Neonatalogy
- Pediatric Neurology
- Critical Care Medicine
Background:
- Intraventricular hemorrhage (IVH) is a significant complication in premature infants.
- Understanding factors associated with IVH development is crucial for prevention and management.
Purpose of the Study:
- To investigate the association between diastolic closing margin (DCM) and the incidence of severe IVH in premature infants.
- To evaluate DCM as a potential indicator of cerebral perfusion abnormalities linked to IVH.
Main Methods:
- Reanalysis of prospectively collected data from 185 premature infants (23-31 weeks gestational age) on mechanical ventilation.
- Continuous monitoring of umbilical arterial blood pressure, middle cerebral artery blood flow velocity, and PaCO2 during the first week of life.
- Multivariate generalized linear regression models were employed to identify associations with severe IVH (grades 3-4).
Main Results:
- Severe IVH occurred in 14.6% of the infants studied.
- Both Apgar score at 5 minutes and DCM were significantly associated with severe IVH.
- A 5-mm Hg increase in DCM correlated with a 1.83- to 1.89-fold increased likelihood of developing severe IVH.
Conclusions:
- Elevated DCM is associated with an increased risk of severe IVH in premature infants.
- Findings support previous animal research linking IVH to cerebral hyperperfusion.
- DCM may offer a more informative measure of cerebral perfusion in neonates compared to traditional blood pressure monitoring.
Objective:
To determine whether the diastolic closing margin (DCM), defined as diastolic blood pressure minus critical closing pressure, is associated with the development of early severe intraventricular hemorrhage (IVH).
Study Design:
A reanalysis of prospectively collected data was conducted. Premature infants (gestational age 23-31 weeks) receiving mechanical ventilation (n = 185) had ∼1-hour continuous recordings of umbilical arterial blood pressure, middle cerebral artery cerebral blood flow velocity, and PaCO2 during the first week of life. Models using multivariate generalized linear regression and purposeful selection were used to determine associations with severe IVH.
Results:
Severe IVH (grades 3-4) was observed in 14.6% of the infants. Irrespective of the model used, Apgar score at 5 minutes and DCM were significantly associated with severe IVH. A clinically relevant 5-mm Hg increase in DCM was associated with a 1.83- to 1.89-fold increased odds of developing severe IVH.
Conclusion:
Elevated DCM was associated with severe IVH, consistent with previous animal data showing that IVH is associated with hyperperfusion. Measurement of DCM may be more useful than blood pressure in defining cerebral perfusion in premature infants.
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