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The Ontogeny of Cerebrovascular Pressure Autoregulation in Premature Infants

Christopher J Rhee1, Charles D Fraser2, Kathleen Kibler3

  • 1Section of Neonatology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin Street, W6-104, Houston, TX, USA. cjrhee@texaschildrens.org.

Acta Neurochirurgica. Supplement
|May 12, 2016
PubMed

Insights

Cerebrovascular autoregulation in premature infants (23-33 weeks gestational age) shows pressure-passive diastolic flow but developing systolic regulation with increasing gestational age. This indicates improving brain blood flow control in early life.

Area of Science:

  • Neonatal Physiology
  • Cerebrovascular Regulation
  • Perinatal Medicine

Background:

  • Premature infants exhibit immature physiological systems, including cerebrovascular regulation.
  • Understanding cerebral blood flow dynamics is crucial for managing neurological outcomes in preterm neonates.

Purpose of the Study:

  • To quantify cerebrovascular autoregulation in premature infants (23-33 weeks gestational age) during the first week of life.
  • To assess how autoregulation varies with gestational age and across different phases of the cardiac cycle.

Main Methods:

  • Utilized umbilical artery catheters and transcranial Doppler to monitor middle cerebral artery flow velocity (FV) in 186 premature infants.
  • Quantified autoregulation using moving correlation coefficients between arterial blood pressure (ABP) and FV (systolic - Sx, mean - Mx, diastolic - Dx).

Main Results:

  • Diastolic cerebral blood flow (Dx) was consistently pressure-passive and showed minimal change with increasing gestational age.
  • Systolic cerebral blood flow (Sx) was pressure-passive at lower gestational ages and demonstrated a significant decrease with increasing gestational age (r = -0.3, p < 0.001).
  • Gestational age and "closing margin" were significant factors associated with systolic autoregulation (Sx).

Conclusions:

  • Premature infants within the 23-33 weeks gestational age range exhibit pressure-passive diastolic cerebral blood flow.
  • Systolic cerebral blood flow regulation via autoregulation becomes evident in this preterm cohort.
  • Findings highlight the developmental trajectory of cerebrovascular autoregulation in early preterm life.

Keywords:
Arterial blood pressureCerebrovascular pressure autoregulationClosing marginPrematurity

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