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Updated: Nov 18, 2025
Transcutaneous Microcirculatory Imaging in Preterm Neonates
Published on: December 31, 2015
Fluctuations in internal cerebral vein and central side veins of preterm infants
Toshifumi Ikeda1,2, Yuya Ito1, Ryosuke Mikami1
1Department of Neonatology, Aomori Prefectural Central Hospital, Aomori, Japan.
Insights
High-grade fluctuations in internal cerebral veins, not other cerebral vessels, are linked to intraventricular hemorrhage (IVH) in extremely low birthweight (ELBW) infants. This finding aids in predicting and managing IVH risk in vulnerable newborns.
Area of Science:
- Neonatal Neurology
- Pediatric Cardiology
- Medical Imaging
Background:
- Extremely low birthweight (ELBW) infants face a high risk of intraventricular hemorrhage (IVH).
- Perfusion waveform fluctuations in cerebral veins are implicated in IVH development.
- Previous studies highlight the association between high-grade fluctuations and IVH incidence.
Purpose of the Study:
- To investigate Doppler perfusion waveform fluctuations in the great cerebral vein, straight sinus, and internal cerebral veins of ELBW infants.
- To determine the correlation between specific venous waveform fluctuation grades and the occurrence of IVH.
- To identify reliable markers for predicting IVH risk in ELBW neonates.
Main Methods:
- A prospective observational study involving 73 ELBW infants (<1,000 g).
- Evaluation of perfusion waveforms every 12 hours for 120 hours post-birth using Doppler ultrasound.
- Categorization of waveform fluctuations into four grades (0-3) based on magnitude.
Main Results:
- High-grade fluctuations (Grades 2-3) were most prevalent in the great cerebral vein (51/73) and straight sinus (67/73).
- Intraventricular hemorrhage (IVH) was significantly associated with high-grade fluctuations specifically in the internal cerebral veins.
- No significant association was found between IVH and high-grade fluctuations in the great cerebral vein or straight sinus.
Conclusions:
- While high-grade fluctuations are common in the great cerebral vein and straight sinus of ELBW infants, they do not predict IVH.
- High-grade perfusion waveform fluctuations in the internal cerebral veins are a significant predictor of intraventricular hemorrhage in ELBW infants.
- Monitoring internal cerebral vein waveforms offers a potential diagnostic tool for assessing IVH risk in extremely premature neonates.
Background:
Studies on the acute management of extremely low birthweight (ELBW) infants reveal a high incidence of intraventricular hemorrhage (IVH) in infants with high-grade internal cerebral vein perfusion waveform fluctuations. In this prospective observational study we investigated the Doppler perfusion waveform fluctuations in the great cerebral vein, straight sinus, and internal cerebral veins of ELBW infants.
Methods:
We evaluated perfusion waveforms after birth every 12 h until 120 h in 73 ELBW infants (<1,000 g) at our hospital. Fluctuations were categorized into four patterns of increasing magnitude, Grades 0-3.
Results:
The maximum grades of perfusion waveform fluctuations of the internal cerebral veins were 0, 1, 2, and 3 detected in 12, 38, 13, and 10 infants, respectively; those of the great cerebral vein were 0, 1, 2, and 3 detected in 5, 17, 20, and 31 infants, respectively; and those of the straight sinus were 0, 1, 2, and 3 detected in 1, 5, 17, and 50 infants, respectively. Only one of 803 simultaneous measurements of the Doppler perfusion waveforms showed stronger fluctuations of the peripheral vein than those of the central side veins. Intraventricular hemorrhage was associated with high-grade fluctuations in the internal cerebral veins but not in the great cerebral vein or straight sinus.
Conclusions:
Most infants had high-grade fluctuations in the great cerebral vein and straight sinus, with lower grade fluctuations in the internal cerebral vein, but IVH was not associated with those markers. Intraventricular hemorrhage was correlated with high-grade fluctuations only in the internal cerebral veins.
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