Cerebral Hemodynamics in Premature Infants
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Extremely low birth weight infants remain at increased risk of intraventricular hemorrhage from the fragile vascular bed of the germinal matrix; the roles of hypotension (ischemia) and reperfusion (hyperemia) in the development of intraventricular hemorrhage are still debated. Cerebrovascular pressure autoregulation protects the brain by maintaining constant cerebral blood flow despite changes in blood pressure. The ontogeny of cerebrovascular pressure autoregulation has not been well established and uncertainty remains about the optimal arterial blood pressure required to support brain perfusion. Another important aspect of premature cerebral hemodynamics is the critical closing pressure––the arterial blood pressure at which cerebral blood flow ceases. Interestingly, in premature infants, the critical closing pressure approximates the mean arterial blood pressure. Often in this unique population, cerebral blood flow occurs only during systole when the diastolic arterial blood pressure is equal to the critical closing pressure. Moreover, the diastolic closing margin, a metric of cerebral perfusion that normalizes diastolic arterial blood pressure to the critical closing pressure, may be a better measure than arterial blood pressure for defining cerebral perfusion in premature infants. Elevated diastolic closing margin has been associated with intraventricular hemorrhage. This review summarizes the current state of understanding of cerebral hemodynamics in premature infants.
Abstract
Extremely low birth weight infants remain at increased risk of intraventricular hemorrhage from the fragile vascular bed of the germinal matrix; the roles of hypotension (ischemia) and reperfusion (hyperemia) in the development of intraventricular hemorrhage are still debated. Cerebrovascular pressure autoregulation protects the brain by maintaining constant cerebral blood flow despite changes in blood pressure. The ontogeny of cerebrovascular pressure autoregulation has not been well established and uncertainty remains about the optimal arterial blood pressure required to support brain perfusion. Another important aspect of premature cerebral hemodynamics is the critical closing pressure––the arterial blood pressure at which cerebral blood flow ceases. Interestingly, in premature infants, the critical closing pressure approximates the mean arterial blood pressure. Often in this unique population, cerebral blood flow occurs only during systole when the diastolic arterial blood pressure is equal to the critical closing pressure. Moreover, the diastolic closing margin, a metric of cerebral perfusion that normalizes diastolic arterial blood pressure to the critical closing pressure, may be a better measure than arterial blood pressure for defining cerebral perfusion in premature infants. Elevated diastolic closing margin has been associated with intraventricular hemorrhage. This review summarizes the current state of understanding of cerebral hemodynamics in premature infants.
참고문헌 (37)
- Hack M, "Young adult outcomes of very-low-birth-weight children", Semin Fetal Neonatal Med, 11, pp.127~137 (2006)[DOI]
- Volpe JJ, "Intraventricular hemorrhage in the premature infant--current concepts. Part I", Ann Neurol, 25, pp.3~11 (1989)[DOI]
- Volpe JJ, "Intraventricular hemorrhage in the premature infant--current concepts. Part II", Ann Neurol, 25, pp.109~116 (1989)[DOI]
- Osborn DA, "Clinical detection of low upper body blood flow in very premature infants using blood pressure, capillary refill time, and central-peripheral temperature difference", Arch Dis Child Fetal Neonatal Ed, 89, pp.F168~F173 (2004)[DOI]
- Watkins AM, "Blood pressure and cerebral haemorrhage and ischaemia in very low birthweight infants", Early Hum Dev, 19, pp.103~110 (1989)[DOI]
- Kluckow M, "Superior vena cava flow in newborn infants: a novel marker of systemic blood flow", Arch Dis Child Fetal Neonatal Ed, 82, pp.F182~F187 (2000)[DOI]
- Kluckow M, "Low systemic blood flow in the preterm infant", Semin Neonatol, 6, pp.75~84 (2001)[DOI]
- Ment LR, "Beagle puppy model of perinatal cerebral infarction", J Neurosurg, 63, pp.441~447 (1985)[DOI]
- Ment LR, "Beagle puppy model of perinatal cerebral insults", J Neurosurg, 65, pp.847~850 (1986)[DOI]
- Soleymani S, "Neonatal hemodynamics: monitoring, data acquisition and analysis", Expert Rev Med Devices, 9, pp.501~511 (2012)[DOI]
- Osborn DA, "Clinical detection of low upper body blood flow in very premature infants using blood pressure, capillary refill time, and central-peripheral temperature difference", Arch Dis Child Fetal Neonatal Ed, 89, pp.F168~F173 (2004)[DOI]
- Laughon M, "Factors associated with treatment for hypotension in extremely low gestational age newborns during the first postnatal week", Pediatrics, 119, pp.273~280 (2007)[DOI]
- Al-Aweel I, "Variations in prevalence of hypotension, hypertension, and vasopressor use in NICUs", J Perinatol, 21, pp.272~278 (2001)[DOI]
- Lou H, "Low cerebral blood flow: a risk factor in the neonate", J Pediatr, 95, pp.606~609 (1979)[DOI]
- Rhee CJ, "Elevated diastolic closing margin is associated with intraventricular hemorrhage in premature infants", J Pediatr, 174, pp.52~56 (2016)[DOI]
- Szymonowicz W, "Regional cerebral blood flow after hemorrhagic hypotension in the preterm, near-term, and newborn lamb", Pediatr Res, 28, pp.361~366 (1990)[DOI]
- Helou S, "Cerebrovascular autoregulation during fetal development in sheep", Am J Physiol, 266, pp.H1069~H1074 (1994)[DOI]
- Lee JK, "Cerebrovascular reactivity measured by near-infrared spectroscopy", Stroke, 40, pp.1820~1826 (2009)[DOI]
- Kaiser JR, "Surfactant administration acutely affects cerebral and systemic hemodynamics and gas exchange in very-low-birth-weight infants", J Pediatr, 144, pp.809~814 (2004)
- Tsuji M, "Cerebral intravascular oxygenation correlates with mean arterial pressure in critically ill premature infants", Pediatrics, 106, pp.625~632 (2000)[DOI]
- Gilmore MM, "Relationship between cerebrovascular dysautoregulation and arterial blood pressure in the premature infant", J Perinatol, 31, pp.722~729 (2011)[DOI]
- Tyszczuk L, "Cerebral blood flow is independent of mean arterial blood pressure in preterm infants undergoing intensive care", Pediatrics, 102, pp.337~341 (1998)[DOI]
- Soul JS, "Fluctuating pressure-passivity is common in the cerebral circulation of sick premature infants", Pediatr Res, 61, pp.467~473 (2007)[DOI]
- O'Leary H, "Elevated cerebral pressure passivity is associated with prematurity-related intracranial hemorrhage", Pediatrics, 124, pp.302~309 (2009)[DOI]
- Kaiser JR, "The effects of hypercapnia on cerebral autoregulation in ventilated very low birth weight infants", Pediatr Res, 58, pp.931~935 (2005)[DOI]
- Kaiser J, "Tracheal suctioning is associated with prolonged disturbances of cerebral hemodynamics in very low birth weight infants", J Perinatol, 28, pp.34~41 (2007)
- Kaiser J, "The effects of closed tracheal suctioning plus volume guarantee on cerebral hemodynamics", J Perinatol, 31, pp.671~676 (2011)[DOI]
- Wong F, "Impaired autoregulation in preterm infants identified by using spatially resolved spectroscopy", Pediatrics, 121, pp.e604~e611 (2008)[DOI]
- Riera J, "New developments in cerebral blood flow autoregulation analysis in preterm infants: a mechanistic approach", Pediatr Res, 79, pp.460~465 (2016)[DOI]
- Rhee CJ, "The ontogeny of cerebrovascular pressure autoregulation in human premature infants", J Perinatol, 34, pp.926~931 (2014)[DOI]
- Nichol J, "Fundamental instability of the small blood vessels and critical closing pressures in vascular beds", Am J Physiol, 164, pp.330~344 (1951)
- Jagersberg M, "Simultaneous bedside assessment of global cerebral blood flow and effective cerebral perfusion pressure in patients with intracranial hypertension", Neurocrit Care, 12, pp.225~233 (2010)[DOI]
- Varsos GV, "Critical closing pressure determined with a model of cerebrovascular impedance", J Cereb Blood Flow Metab, 33, pp.235~243 (2013)[DOI]
- Panerai R, "A model of the instantaneous pressure-velocity relationships of the neonatal cerebral circulation", Physiol Meas, 14, pp.411~418 (1993)[DOI]
- Panerai R, "Estimation of critical closing pressure in the cerebral circulation of newborns", Neuropediatrics, 26, pp.168~173 (1995)[DOI]
- Rhee CJ, "Ontogeny of critical closing pressure", Pediatr Res, 78, pp.71~75 (2015)[DOI]
- Nelson RJ, "Experimental aspects of cerebrospinal hemodynamics: the relationship between blood flow velocity waveform and cerebral autoregulation", Neurosurgery, 31, pp.705~710 (1992)