Neonatal cerebral blood flow velocity responses to changes in posture

Maintaining a constant cerebral blood flow during a change in cerebral perfusion pressure is known as autoregulation. The integrity of this phenomenon is considered to be important in preventing cerebral lesions in preterm infants. A study was carried out using Doppler ultrasound measurements of cerebral blood flow velocities (CBFV) as an indicator of alterations in cerebral haemodynamics. CBFV were recorded on a beat to beat basis over 60 second epochs, during which time the cerebral perfusion pressure was changed by rapidly altering the infants' posture from horizontal to either 20 degrees head up or head down. An informative response in CBFV was considered to be either (a) a uniphasic, immediate, passive alteration in velocity occurring with the change in posture and without a subsequent change or (b) a biphasic response of an initial change in CBFV followed within 20 seconds by a second response. This latter response is considered to be consistent with autoregulatory activity. A total of 501 epochs in 60 neonates of gestational age 24-41 weeks was analysed. It was shown that any one infant can make either response, but the reliability of making an active, biphasic response increases with increasing gestational age.