Aetiological Rôle Of Cerebral Blood‐Flow Alterations In Development And Extension Of Peri‐Intraventricular Haemorrhage

Bel, Frank van; Bor, Margot van de; Stijnen, Theo; Baan, Jan; Ruys, J.H.

doi:10.1111/j.1469-8749.1987.tb08502.x

Cited by 85 publications

(8 citation statements)

References 41 publications

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“…These findings have important implications for clinical management; an adjunctive measure of response to inotropic medications may allow for more rapid, optimal titration, decreasing the possible risk of ischemia-reperfusion and hypertensioninduced IVH (26). Indeed, there is significant evidence in the cerebral autoregulation literature to suggest that merely im- proving the MABP does not necessarily indicate that autoregulation has been restored or is more active (9,13).…”

Section: Discussionmentioning

confidence: 99%

Low-frequency blood pressure oscillations and inotrope treatment failure in premature infants

Vesoulis

Hao

McPherson

et al. 2017

Journal of Applied Physiology

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The underlying mechanism as to why some hypotensive preterm infants do not respond to inotropic medications remains unclear. For these infants, we hypothesize that impaired vasomotor function is a significant factor and is manifested through a decrease in low-frequency blood pressure variability across regulatory components of vascular tone. Infants born ≤28 wk estimated gestational age underwent prospective recording of mean arterial blood pressure for 72 h after birth. After error correction, root-mean-square spectral power was calculated for each valid 10-min data frame across each of four frequency bands (, 0.005-0.0095 Hz; , 0.0095-0.02 Hz;, 0.02-0.06 Hz; and , 0.06-0.16) corresponding to different components of vasomotion control. Forty infants (twenty-nine normotensive control and eleven inotrope-exposed) were included with a mean ± SD estimated gestational age of 25.2 ± 1.6 wk and birth weight 790 ± 211 g. 9.7/11.8 Million (82%) data points were error-free and used for analysis. Spectral power across all frequency bands increased with time, although the magnitude was 20% less in the inotrope-exposed infants. A statistically significant increase in spectral power in response to inotrope initiation was noted across all frequency bands. Infants with robust blood pressure response to inotropes had a greater increase compared with those who had limited or no blood pressure response. In this study, hypotensive infants who require inotropes have decreased low-frequency variability at baseline compared with normotensive infants, which increases after inotrope initiation. Low-frequency spectral power does not change for those with inotrope treatment failure, suggesting dysfunctional regulation of vascular tone as a potential mechanism of treatment failure. In this study, we examine patterns of low-frequency oscillations in blood pressure variability across regulatory components of vascular tone in normotensive and hypotensive infants exposed to inotropic medications. We found that hypotensive infants who require inotropes have decreased low-frequency variability at baseline, which increases after inotrope initiation. Low-frequency spectral power does not change for those with inotrope treatment failure, suggesting dysfunctional regulation of vascular tone as a potential mechanism of treatment failure.

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Section: Discussionmentioning

confidence: 99%

Low-frequency blood pressure oscillations and inotrope treatment failure in premature infants

Vesoulis

Hao

McPherson

et al. 2017

Journal of Applied Physiology

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“…Infants who developed severe IVH had considerably higher variation in RI and AUVC in the first postnatal week. 23 A conclusive temporal relationship between Doppler changes and the onset of bleeding has not be established so far (Fig. 8).…”

Section: Intraventricular/intracerebral Hemorrhagementioning

confidence: 98%

Transcranial Doppler: A New Stethoscope–Voiceover Tool for Neonatal Brain

Maheshwari,

Patodia,

Suryawanshi

et al. 2024

Newborn

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Background: Cerebral Doppler ultrasound is an emerging bedside tool to measure cerebral perfusion in premature and critically ill neonates. The review focused on maturation and disease-associated Doppler spectra in neonates for diagnostic and prognostic relevance and to identify relevant research areas. Methods: A comprehensive literature search was conducted to review cerebral Doppler parameters noted in specific disease states. Further efforts were focused to understand the clinical relevance of these indices in the management of neonates and to predict their long-term neurodevelopmental outcomes. Results: The review focused on routinely used cerebral Doppler parameters in normal and diseased states. Resistive index (RI) in the anterior cerebral artery (ACA) is a frequently used parameter in infants with primary brain injury and in preterm neonates with hemodynamically significant patent ductus arteriosus (HsPDA). Conclusion: Despite extensive use, major gaps remain in our understanding of cerebral Doppler parameters for diagnosis, monitoring, and prediction of neurodevelopmental outcomes in neonates. Further studies are needed to decode these data in a more precise manner.

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“…This is clinically represented by the idiopathic respiratory distress syndrome (IRDS), and (functional) immaturity of the cerebral vascular bed (Ozdemir et al., 1997; Krediet et al., 2006; Ballabh, 2014). IRDS may lead to hypoxia and hypercapnia, lack of cerebral autoregulation and the need for blood pressure support often causing fluctuations and hyperperfusion of the immature brain of the extremely and very preterm infant (Perlman et al., 1985; van Bel et al., 1987), although this mechanism may also be operative in the moderate and late preterm neonate with IRDS (Thygesen et al., 2016). Cerebral hemodynamic instability often leads to PIVH, mostly originating in the germinal matrix, which has a dense but fragile vasculature (Ballabh, 2014).…”

Section: Periventricular-intraventricular Hemorrhagementioning

confidence: 99%

Prevention, Reduction and Repair of Brain Injury of the Preterm Infant

2019

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Periventricular-intraventricular hemorrhages (PIVH) and (diffuse) white matter injury (WMI) are the most important acquired brain lesions of the very and extremely prematurely born neonate. Both carry a high risk for death or adverse neurodevelopmental outcome. The first part of the review discusses the standard of care and latest insights with respect to prevention and/or reduction of PIVH and WMI, taking into account their etiopathogenesis which is tightly linked to (functional) immaturity of the cerebral vascular bed and nervous system and commonly encountered inflammation. The second part discusses repair of hemorrhagic-ischemic and post-inflammatory brain lesions as it is an increasingly important topic in newborn medicine. In the near future trials of trophic and (autologous or allogenic) cell-therapy in infants at risk of or demonstrating established PIVH and WMI will be started. The focus of these potential trials will be discussed.

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Aetiological Rôle Of Cerebral Blood‐Flow Alterations In Development And Extension Of Peri‐Intraventricular Haemorrhage

Cited by 85 publications

References 41 publications

Low-frequency blood pressure oscillations and inotrope treatment failure in premature infants

Low-frequency blood pressure oscillations and inotrope treatment failure in premature infants

Transcranial Doppler: A New Stethoscope–Voiceover Tool for Neonatal Brain

Prevention, Reduction and Repair of Brain Injury of the Preterm Infant

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