Cerebral Hemodynamic Changes During Intensive Care of Preterm Infants

Abstract

OBJECTIVES The objectives of this study were to examine the circulatory changes experienced by the immature systemic and cerebral circulations during routine events in the critical care of preterm infants and to identify clinical factors that are associated with greater hemodynamic-oxygenation changes during these events. METHODS We studied 82 infants who weighed <1500 g at birth and required intensive care management and continuous blood pressure monitoring from an umbilical arterial catheter. Continuous recording of cerebral and systemic hemodynamic and oxygenation changes was performed. We studied 6 distinct types of caregiving events during 10-minute epochs: (1) quiet baseline periods; (2) minor manipulation; (3) diaper changes; (4) endotracheal tube suctioning; (5) endotracheal tube repositioning; and (6) complex events. Each event was matched with a preceding baseline. We examined the effect of specific clinical factors and cranial ultrasound abnormalities on the systemic and cerebral hemodynamic oxygenation changes that were associated with the various event types. RESULTS There were highly significant differences in hemodynamics and oxygenation between events overall and baseline epochs. The magnitude of these circulatory changes was greatest during endotracheal tube repositioning and complex caregiving events. Lower gestational age, higher illness severity, chorioamnionitis, low Apgar scores, and need for pressor-inotropes all were associated with circulatory changes of significantly lower magnitude. Cerebral hemodynamic changes were associated with early parenchymal ultrasound abnormalities. CONCLUSIONS Routine caregiving procedures in critically ill preterm infants are associated with major circulatory fluctuations that are clinically underappreciated and underdetected by current bedside monitoring. Our data underscore the importance of continuous cerebral hemodynamic monitoring in critically ill preterm infants.

Fatores associados ao atraso do desenvolvimento motor de crianças prematuras internadas em unidade de neonatologia

“…12 A ventilação mecânica limita a variação de posição do neonato, 26 restringindo seus movimentos espontâ-neos, 6 além de provocar alterações hemodinâmicas e na oxigenação tecidual, que podem favorecer lesões neurológicas, 27 de modo que têm sido associada ao desenvolvimento motor em avaliações precoces 28 e tardias. 1,4 Embora o presente estudo tenha mostrado uma tendência a piores resultados motores com o aumento no tempo de oxigenoterapia e de permanência da criança na ventilação mecânica, não foi possível estabelecer uma relação causal direta desses fatores com atraso do desenvolvimento, pois crianças que utilizaram tais recursos por períodos prolongados foram também as mais graves.…”

Precision of cerebral oxygenation and hemoglobin concentration measurements in neonates measured by near-infrared spectroscopy

“…1,2 To allow prevention or early intervention, continuous cerebral monitoring is important to detect cerebral aberrations in term and preterm neonates undergoing intensive care. [3][4][5] Near-infrared spectroscopy (NIRS) is a continuous and also noninvasive method to measure regional changes in cerebral tissue oxygenation and perfusion at the bedside. 6,7 Thus, NIRS is suitable for cerebral monitoring.…”

Intrauterine inflammation alters cardiopulmonary but not cerebral hemodynamics during open endotracheal tube suction in preterm lambs

“…Experimental and clinical evidence show that the cardiopulmonary and systemic circulations are adversely affected in preterm neonates exposed to intrauterine inflammation (2)(3)(4)(5). This is probably caused by inflammationinduced impairment in pulmonary and systemic vascular development and function (4,(6)(7)(8)(9)(10)(11).…”

“…Endotracheal tube (ETT) suction is one of the most common interventions performed during respiratory support of preterm infants and is known to alter lung mechanics and systemic hemodynamics (3,(16)(17)(18)(19)(20). However, to our knowledge, the impact of prior exposure to intrauterine inflammation on these consequences is unknown.…”