Changes in Skin and Subcutaneous Perfusion in Very-Low-Birth-Weight Infants during the Transitional Period

Abstract

Background: Conventional parameters of circulation that are routinely used in neonatal intensive care units, including blood pressure, have been reported to be inadequate in improving prognosis of very-low-birth-weight (VLBW) infants. Recently, the importance of evaluating the blood flow to each organ, including both vital and nonvital organs, has been increasingly recognized. Objectives: To study the changes in peripheral perfusion occurring in VLBW infants of less than 32 weeks’ gestation during the extrauterine transitional period. Methods: In 32 VLBW infants of less than 32 weeks’ gestation, forehead blood flow (FBF) and lower-limb blood flow (LBF) were measured for 48 h after birth using a novel laser Doppler flowmeter, and the indices of vascular resistance were estimated. Superior vena cava (SVC) blood flow was measured by echocardiography. Changes in these variables of circulation as well as the correlations were evaluated. Results: Both FBF and LBF significantly increased at 24 h, while the SVC flow remained unchanged over the same period. Both forehead and lower-limb vascular resistance indices significantly decreased at 24 h. LBF was negatively and positively correlated with estimated upper body vascular resistance and SVC flow, respectively. Conclusions: The increase in the peripheral blood flow along with the decrease in the peripheral vascular resistance indices, without an increase in the systemic blood flow at 24 h of age, indicated vasodilation in skin and subcutaneous tissue during the transitional period in VLBW infants. FBF and LBF can be useful parameters as indicators of both peripheral and systemic circulation.

Effect of dopamine on peripheral perfusion in very-low-birth-weight infants during the transitional period

“…As discussed in our previous studies (8,23), this difference may be explained by differences in autonomic innervation between the skin over the forehead and that over the lower limbs. LBF seems to be a more sensitive measure of circulatory changes and a better indicator of skin perfusion and subcutaneous perfusion responses to treatment.…”

“…A noninvasive continuous monitoring technique was used for measuring skin and subcutaneous blood flow, as described in our previous studies (8,23). Probes were attached to the middle of the forehead and to the dorsum of the right or left foot, avoiding visible vessels.…”

“…In our previous study, we reported the changes in skin and subcutaneous blood flow in VLBW infants during the extrauterine transitional period (8). Our current study aimed to elucidate the action of dopamine on peripheral perfusion, as measured by skin and subcutaneous blood flow, in VLBW infants.…”

Skin blood flow as a predictor of intraventricular hemorrhage in very-low-birth-weight infants

“…The reasons behind the correlation between LBF and IVH and the lack of correlation between FBF and IVH are unclear. We previously reported a positive but weak correlation between LBF and superior vena cava blood flow (20). Superior vena cava blood flow has been used as a marker of upper-body systemic blood flow, including venous return from the brain (21).…”

“…A noninvasive continuous monitoring technique was used for measuring skin and subcutaneous blood flow, as described in our previous studies (20,31). In brief, the system comprised a laser Doppler flowmeter (CDF-2000; Nexis, Fukuoka, Japan), a probe, and a computer.…”