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Hypertensive response to raised intracranial pressure in infancy

A M Kaiser1, A G Whitelaw

  • 1Department of Paediatrics and Neonatal Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London.

Archives of Disease in Childhood
|December 1, 1988
PubMed

Insights

In infants with intracranial hypertension, rising blood pressure often fails to compensate for increased intracranial pressure, leading to decreased cerebral perfusion pressure. Maintaining blood pressure is crucial for managing acute encephalopathy.

Area of Science:

  • Pediatric Neurology
  • Critical Care Medicine
  • Neonatology

Background:

  • Intracranial hypertension is a critical condition in infants, potentially leading to severe neurological damage.
  • Cerebral perfusion pressure (CPP) is vital for adequate brain blood flow and is calculated as mean arterial pressure (MAP) minus intracranial pressure (ICP).
  • Understanding the relationship between MAP, ICP, and CPP is essential for optimizing treatment strategies in infants.

Purpose of the Study:

  • To investigate the relationship between mean arterial pressure (MAP) and intracranial pressure (ICP) in infants with intracranial hypertension.
  • To determine how changes in ICP affect CPP in this vulnerable population.
  • To evaluate the adequacy of blood pressure support in maintaining cerebral perfusion.

Main Methods:

  • Serial measurements of MAP and ICP were performed in six infants diagnosed with intracranial hypertension (ICP > 20 mm Hg).
  • Cerebral perfusion pressure (CPP) was calculated using the formula: CPP = MAP - ICP.
  • Data analysis focused on the rate of change in MAP and CPP relative to changes in ICP.

Main Results:

  • Mean arterial pressure (MAP) increased with rising intracranial pressure (ICP) at a mean rate of 0.20 mm Hg/mm Hg.
  • Cerebral perfusion pressure (CPP) decreased with increasing ICP at a mean rate of 0.80 mm Hg/mm Hg overall.
  • One infant demonstrated well-maintained CPP despite rising ICP, indicating variability in response.

Conclusions:

  • The typical rise in MAP is insufficient to fully compensate for elevated ICP in infants, often resulting in reduced CPP.
  • Vigorous blood pressure support is as critical as ICP-lowering strategies for infants with acute encephalopathy.
  • Optimizing MAP is a key therapeutic goal to ensure adequate CPP and prevent secondary brain injury in infants with intracranial hypertension.

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