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The Ontogeny of Cerebrovascular Critical Closing Pressure

Christopher J Rhee1, Charles D Fraser2, Kathleen Kibler3

  • 1Department of Pediatrics, Section of Neonatology, 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

Critical closing pressure (CrCP) defines cerebral blood flow cessation in premature infants. This study found CrCP increases with gestational age, potentially explaining how these infants tolerate low arterial blood pressure.

Area of Science:

  • Neonatal Neurology
  • Vascular Physiology
  • Pediatric Cardiology

Background:

  • Premature infants face risks of neurological damage from blood pressure fluctuations.
  • Defining injurious hypotension and hypertension in neonates lacks consensus.
  • Critical closing pressure (CrCP) offers a potential subject-specific measure of cerebral perfusion pressure.

Purpose of the Study:

  • To quantify Critical Closing Pressure (CrCP) in premature infants.
  • To determine the relationship between CrCP and gestational age (GA).
  • To explore the association of CrCP with arterial blood pressure (ABP) parameters.

Main Methods:

  • Utilized data from 186 premature infants (GA 23-33 weeks) over the first week of life.
  • Employed umbilical artery catheters and middle cerebral artery Doppler for flow velocity (FV) monitoring.
  • Calculated CrCP using an impedance model with cerebrovascular resistance and compliance estimations.

Main Results:

  • CrCP significantly increased with gestational age (r=0.47, p < 0.001).
  • Higher diastolic arterial blood pressure (ABP) and GA were linked to increased CrCP (p < 0.001).
  • CrCP showed a notable rise towards the end of the second and start of the third trimester.

Conclusions:

  • Gestational age is a significant determinant of Critical Closing Pressure in premature infants.
  • The findings suggest CrCP may define personalized safe arterial blood pressure ranges.
  • Low CrCP in preterm neonates might explain their tolerance to low ABP, preventing brain injury.

Keywords:
Arterial blood pressureClosing marginCritical closing pressurePrematurity

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