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Alterations in cerebral blood flow in preterm infants with intraventricular hemorrhage
Insights
Early hemispheric cerebral blood flow (HCBF) in preterm infants with germinal matrix hemorrhages (GMH) or intraventricular hemorrhages (IVH) showed discrepancies. These flow differences resolved by 37 weeks postconceptual age.
Area of Science:
- Neonatal Neurology
- Pediatric Radiology
- Cerebrovascular Physiology
Background:
- Preterm infants, especially those weighing less than 1,250 gm, are at high risk for germinal matrix hemorrhages (GMH) and intraventricular hemorrhages (IVH).
- Understanding cerebral blood flow (CBF) dynamics is crucial for assessing brain injury in neonates.
Purpose of the Study:
- To correlate Xenon-133 inhalation hemispheric cerebral blood flow (HCBF) measurements with computed tomography (CT) and autopsy findings in preterm infants.
- To investigate the temporal changes in HCBF in relation to GMH/IVH development and resolution.
Main Methods:
- Xenon-133 inhalation technique was used to determine HCBF in 15 preterm infants (birth weight < 1,250 gm) at different postnatal ages and at 37 weeks postconceptual age.
- HCBF data were correlated with CT scans and autopsy findings, with a focus on infants diagnosed with GMH or IVH.
Main Results:
- At 1-2 days postnatal, no mean HCBF difference was observed between infants with and without GMH/IVH, but hemispheric flow ratios showed significant discrepancies in the GMH/IVH group.
- Asymmetric hemorrhages on CT scans correlated with higher flow on the affected side in 4 out of 5 cases.
- At 4-6 days postnatal, GMH/IVH patients had lower mean HCBF values, and interhemispheric ratio differences persisted.
- By 37 weeks postconceptual age, no significant differences in mean HCBF or hemispheric ratios were found between the groups.
Conclusions:
- Early HCBF hemispheric flow ratios can reveal discrepancies in preterm infants with GMH/IVH, even when mean flow is unchanged.
- HCBF patterns in infants with GMH/IVH normalize by term-equivalent age, suggesting potential for recovery or adaptation.
- HCBF assessment may offer valuable insights into the pathophysiology and evolution of brain injury in high-risk preterm infants.
Abstract:
Xenon-133 inhalation hemispheric cerebral blood flow (HCBF) determinations at one to two days and four to six days postnatally and at 37 weeks postconceptual age have been correlated with computed tomography (CT) scan and autopsy findings in 15 preterm infants weighing less than 1,250 gm at birth. Ten of these infants had germinal matrix hemorrhages (GMH) or intraventricular hemorrhages (IVH). Although HCBF obtained at one to two days showed no mean difference between the GMH/IVH group and the nonhemorrhage infants, hemispheric flow ratios showed significant discrepancies in the GMH/IVH group. In addition, in four of five patients in whom the hemorrhage appeared asymmetric on CT scan, the side of higher flow correlated with the hemorrhage. At four to six days HCBF showed a lower mean value in the GMH/IVH patients than in the nonhemorrhage patients and differences in the interhemispheric ratios in the GMH/IVH group persisted. There were no differences in the mean HCBF values or hemispheric ratios between the two groups of infants at 37 weeks postconceptual age.