An estimation of intracranial blood flow in the new-born infant

1. A non-invasive method for the estimation of the intracranial blood flow of the new-born infant is described, and results obtained with it are presented. 2. The technique is a novel application of the principle of blood flow measurement by venous occlusion plethysmography. It is possible to apply a plethysmographic technique to the neonatal cranium because the presence of open sutures between the component bones permits small, but readily measurable, changes in intracranial volume to occur. 3. Skull volume changes are calculated from changes in the occipito-frontal circumference of the cranium as recorded and measured with a mercury-in-Silastic strain gauge. 4. The jugular veins in the baby's neck are occluded by finger pressure and there follows an increase in skull volume, which is rapid at first, but which decreases exponentially as venous drainage diverts to non-occluded channels such as the vertebral venous plexus. At the instant of jugular occlusion the rate of skull volume increase is representative of the rate of flow in the jugular vessels prior to occlusion, and so provides an index of the relative magnitude of the intracranial blood flow. The method thus allows changes in intracranial blood flow to be followed. When occlusion is released cranial volume decreases, initially rapidly, but slowing exponentially as resting volume is regained. 5. A theoretical model of the events occurring during the inflow and outflow phases has been developed, and a formula derived which allows an estimation to be made of the flow of blood through uncompressed channels. The measured value of jugular blood flow can then be augmented to an estimate of total intracranial flow. 6. The mean cerebral blood flow of sixteen normal babies was estimated to be 40 ml. 100 g-1.min-1 (S.D. = +/- 11.63).