Blood flow distribution in the normal human preterm brain

Disturbances in cerebral blood flow (CBF) are a major factor in the etiology and pathogenesis of cerebral damage in the neonate. As most animals are more mature at birth than man, extrapolation from animal studies to the human is questionable. Therefore, we have measured regional CBF (rCBF) in preterm infants. rCBF flow was measured in 12 normotensive and normoxic preterm infants [mean birth weight 915 g (range 550 to 2680 g), mean gestational age 27.7 wk (25 to 32 wk)]. All infants had a normal cerebral ultrasound examination. rCBF was measured using a mobile brain dedicated fast-rotating four-head multidetector system specially designed for neonatal studies. The tracer was 99mTc-labeled D,L-hexamethylpropylenamine oxime in a dose of 4 Mbq/kg. rCBF of the subcortical white matter was 0.53 (0.48-0.58) of the global CBF. After correction for scattered radiation, the estimate of rCBF to the white matter was reduced to 0.39 (0.36-0.42). The flow to the basal ganglia was 2.33 (2.08-2.59) times the global CBF. After correction for partial volume effect, the cortical flow was higher than the flow to the basal ganglia and highest in the frontotemporal cortex (motor cortex). The flow to the cerebellum was of the same magnitude as the flow to the basal ganglia, but with a significantly higher variation. rCBF in 12 preterm infants showed a flow distribution similar to flow in other newborn mammals. The gray-white matter contrast, however, was greater. This new information, combined with existing data showing low global CBF, suggests that blood flow to the white matter in the preterm human neonate is extremely low.