Intracranial pressure. Sequential measurements in full-term and preterm infants
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Insights
Intracranial pressure (ICP) monitoring in newborns using a fiberoptic device revealed distinct patterns in full-term and preterm infants. Recent improvements in care for preterm infants appear to correlate with more stable ICP readings.
Area of Science:
- Neonatal Physiology
- Pediatric Neurology
Background:
- Intracranial pressure (ICP) is a critical indicator of neurological status in newborns.
- Accurate ICP monitoring is essential for timely intervention in at-risk infants.
Purpose of the Study:
- To sequentially measure and analyze intracranial pressure (ICP) in full-term and preterm infants during the first week of life.
- To investigate potential correlations between ICP values and clinical factors such as birth weight, gestational age, and respiratory support.
Main Methods:
- Utilized a pressure-activated fiberoptic device placed over the anterior fontanel for non-invasive ICP measurement.
- Monitored 120 full-term and 53 preterm infants during their first postnatal week.
- Recorded ICP values on specific days post-birth (Days 1-3 for full-term; Days 1-3, 5, 7 for preterm).
Main Results:
- Mean ICP in full-term infants was 12.6 cm H2O (Day 1), 12.1 cm H2O (Day 2), and 11.4 cm H2O (Day 3).
- Mean ICP in preterm infants varied: 10.2 cm H2O (Day 1), 17.0 cm H2O (Day 2), 11.0 cm H2O (Day 3), 8.9 cm H2O (Day 5), and 7.3 cm H2O (Day 7).
- Higher ICP values in preterm infants were associated with continuous positive airway pressure (CPAP) via nasal prongs; however, recent preterm infants show more stable ICP, possibly due to improved care, such as reduced hypoxemia.
Conclusions:
- ICP monitoring provides valuable insights into neonatal neurological status.
- ICP trends differ between full-term and preterm infants, with preterm infants exhibiting greater variability.
- Changes in clinical management, including respiratory support and reduction of hypoxemia, may positively influence ICP stability in preterm neonates.
Abstract:
Intracranial pressure (ICP) was measured sequentially using a pressure-activated fiberoptic device that is placed over the anterior fontanel in 120 full-term and 53 preterm infants during the first week after birth. Mean birth weight in full-term infants was 3,527 g (range, 2,720 to 4,620 g) and in preterm infants was 1,695 g (range 1,130 to 2,440 g). Mean ICP was 12.6, 12.1, and 11.4 cm H2O on days 1,2, and 3 in full-term infants, and was 10.2, 17.0, 11.0, 8.9, 7.3 cm H20 on days 1, 2, 3, 5, 7 in preterm infants. The values in preterm infants did not seem to be related to differences in Apgar scores, but higher values were seen in infants treated with continuous positive airway pressure administered by nasal prongs (before the method of fixation was changed). More stable values have been seen recently in preterm infants, which may reflect changes in care (eg, less hypoxemia).