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Cerebrovascular autoregulation and preterm brain injury: a systematic review and meta-analysis
Celina L Brunsch1, Bineta E Lahr2, Elisabeth M W Kooi2
1Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands. c.l.brunsch@umcg.nl.
Insights
Impaired cerebrovascular autoregulation (CAR) is linked to cerebral injury in preterm neonates. This meta-analysis confirms this association, emphasizing CAR assessment
Area of Science:
- Neonatal Neurology
- Cerebrovascular Physiology
- Medical Statistics
Background:
- Preterm neonates face risks of cerebral injury due to impaired cerebrovascular autoregulation (CAR).
- Intraventricular hemorrhage and periventricular leukomalacia are common cerebral injuries in this population.
- Near-infrared spectroscopy is a primary technique for assessing CAR.
Purpose of the Study:
- To evaluate the association between the degree of CAR and cerebral injury in preterm neonates.
- To compare different CAR assessment techniques.
- To synthesize evidence on CAR's role in preterm brain injury.
Main Methods:
- Systematic search of PubMed and EMBASE (2000-2023).
- Inclusion of 17 original articles with 742 patients.
- Meta-analysis of standardized mean difference in CAR between neonates with and without cerebral injury.
Main Results:
- A significant association was found: impaired CAR (SMD 0.59) is more prevalent in neonates with cerebral injury.
- Time-domain analysis showed the least heterogeneity and most significant difference (SMD 0.61).
- Limitations include varied measurement techniques and lack of RCTs.
Conclusions:
- CAR assessment is clinically relevant for identifying cerebral injury risk in preterm neonates.
- Standardized CAR measurement techniques are needed.
- Future RCTs should explore CAR-guided hemodynamic management.
Background:
Preterm neonates are vulnerable to impaired cerebrovascular autoregulation (CAR), with a risk of developing cerebral injury (intraventricular hemorrhage or periventricular leukomalacia). In this meta-analysis, we evaluate the association between the degree of CAR and cerebral injury in preterm neonates, using various CAR assessment techniques mainly based on near-infrared spectroscopy.
Methods:
We systematically searched PubMed and EMBASE between 01-05-2023 and 31-01-2024. We included original articles published between 2000-2023, reporting CAR and cerebral injury in preterm neonates. The study was registered in PROSPERO (ID: 427323). We assessed the standardized mean difference in degree of CAR in groups with and without cerebral injury, with a subgroup analysis of CAR measurement techniques.
Results:
Seventeen articles were included, encompassing 742 patients. The overall standardized mean difference of 0.59 (95%CI 0.30, 0.88) indicates more impaired CAR in neonates with cerebral injury. Time-domain analysis produced the least heterogeneous and most significant difference of 0.61 (95%CI 0.24, 0.98). Limitations include differences in measurement techniques and a lack of randomized controlled trials.
Conclusion:
This meta-analysis showed an association between CAR and cerebral injury, highlighting the clinical relevance of CAR assessment in preterm neonates. Future randomized studies using standardized measurement techniques should assess the feasibility of CAR-guided hemodynamic management.
Impact:
Cerebral injury and adverse neurological outcomes are prevalent in preterm neonates. Historically, immature cerebrovascular autoregulation was thought to be one of the main causes of cerebral injury in this patient population. This is the first study to systematically review and synthetize robust evidence on the relation between cerebrovascular autoregulation and preterm brain injury. This meta-analysis further adds to the existing literature by comparing different cerebrovascular autoregulation measurement techniques. The findings can help to standardize cerebrovascular autoregulation assessment and implement it in clinical practice using large, randomized trials.
