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Assessing key clinical parameters before and after intraventricular hemorrhage in very preterm infants
Renée Lampe1, Esther Rieger-Fackeldey2, Irina Sidorenko3
1School of Medicine, Klinikum rechts der Isar, Orthopedic Department, Research Unit for Pediatric Neuroorthopedics and Cerebral Palsy of the Buhl-Strohmaier Foundation, Technical University of Munich, Ismaningerstr 22, 81675, Munich, Germany. renee.lampe@tum.de.
Insights
Intraventricular cerebral hemorrhage (IVH) in preterm infants is linked to unstable cerebral blood flow (CBF) and abnormal blood pressure and carbon dioxide levels. These factors, particularly high CBF variability, may contribute to IVH development.
Area of Science:
- Neonatal Neurology
- Pediatric Cardiology
- Medical Physics
Background:
- Intraventricular cerebral hemorrhage (IVH) is a severe complication in premature infants, often causing long-term disability.
- Key factors influencing IVH include mean arterial pressure (MAP), arterial carbon dioxide pressure (pCO2), and cerebral blood flow (CBF).
- Premature infants have underdeveloped autoregulation, making them susceptible to CBF fluctuations.
Purpose of the Study:
- To assess changes in MAP, pCO2, and CBF before and after IVH in preterm infants.
- To compare these parameters between infants with and without IVH.
- To identify potential contributors to IVH development.
Main Methods:
- Retrospective review of clinical records for 254 preterm infants (23-30 weeks gestation).
- Analysis of MAP and pCO2 data within 7 days before and 3 days after IVH, or within the first 10 days for controls.
- Computation of mean values and mean absolute deviations of CBF.
Main Results:
- Infants with IVH showed significantly higher pCO2 and lower MAP compared to controls.
- While mean CBF values were similar, the mean absolute deviations of CBF were significantly higher in the IVH group.
- This indicates increased CBF variability in infants who develop IVH.
Conclusions:
- Elevated pCO2 (hypercapnia) and decreased MAP (hypotension) are associated with IVH.
- Significant deviations and variability in CBF, alongside hypercapnia and hypotension, likely contribute to cerebral vessel rupture and IVH.
- Numerical simulation of CBF shows promise for managing preterm infants at risk.
Abstract:
Intraventricular cerebral hemorrhage (IVH) is one of the most severe complications of premature birth, potentially leading to lifelong disability. The purpose of this paper is the assessment of the evolution of three of the most relevant parameters, before and after IVH: mean arterial pressure (MAP), arterial carbon dioxide pressure (pCO2), and cerebral blood flow (CBF). Clinical records of 254 preterm infants with a gestational age of 23-30 weeks, with and without a diagnosis of IVH, were reviewed for MAP and arterial pCO2 in the period up to 7 days before and 3 days after IVH or during the first 10 days of life in cases without IVH.Conclusion: A statistically significant increase in pCO2 and decrease in MAP in patients with IVH compared with those without were detected. Both the mean values and the mean absolute deviations of CBF were computed in this study, and the latter was significantly higher than in control group. High deviations of CBF, as well as hypercapnia and hypotension, are likely to contribute to the rupture of cerebral blood vessels in preterm infants, and consequently, to the development of IVH.What is Known:• The origin of IVH is multifactorial, but mean arterial pressure, carbon dioxide partial pressure, and cerebral blood flow are recognized as the most important parameters.• In premature infants, the autoregulation mechanisms are still underdeveloped and cannot compensate for cerebral blood flow fluctuations.What is New:• The numerical simulation of CBF is shown to be a promising approach that may be useful in the care of preterm infants.• The mean values of CBF before and after IVH in the affected group were similar to those in the control group, but the mean absolute deviations of CBF in the affected group before and after IVH were significantly higher than that in the control group.
