Reduced cerebral blood flow and oxygen metabolism in extremely preterm neonates with low-grade germinal matrix- intraventricular hemorrhage

Abstract

Low-grade germinal matrix-intraventricular hemorrhage (GM-IVH) is the most common complication in extremely premature neonates. The occurrence of GM-IVH is highly associated with hemodynamic instability in the premature brain, yet the long-term impact of low-grade GM-IVH on cerebral blood flow and neuronal health have not been fully investigated. We used an innovative combination of frequency-domain near infrared spectroscopy and diffuse correlation spectroscopy (FDNIRS-DCS) to measure cerebral oxygen saturation (SO2) and an index of cerebral blood flow (CBFi) at the infant’s bedside and compute an index of cerebral oxygen metabolism (CMRO2i). We enrolled twenty extremely low gestational age (ELGA) neonates (seven with low-grade GM-IVH) and monitored them weekly until they reached full-term equivalent age. During their hospital stay, we observed consistently lower CBFi and CMRO2i in ELGA neonates with low-grade GM-IVH compared to neonates without hemorrhages. Furthermore, lower CBFi and CMRO2i in the former group persists even after the resolution of the hemorrhage. In contrast, SO2 does not differ between groups. Thus, CBFi and CMRO2i may have better sensitivity than SO2 in detecting GM-IVH-related effects on infant brain development. FDNIRS-DCS methods may have clinical benefit for monitoring the evolution of GM-IVH, evaluating treatment response, and potentially predicting neurodevelopmental outcome.

Cerebral Perfusion Is Perturbed by Preterm Birth and Brain Injury

“…7,28 Increases in physiologic stress and metabolic demand, either in utero or during the early extrauterine life, may exceed the ability of the increase in cerebral blood flow. 7 Our finding of decreased CBF in PT infants with BI corroborates a previous study by Lin et al, 29 using near-infrared spectroscopy and diffuse correlation spectroscopy imaging. However, ASL-MR imaging has an advantage over the previous method because it is a direct quantitative technique for assessing cerebral perfusion.…”

Clinical applications of near-infrared diffuse correlation spectroscopy and tomography for tissue blood flow monitoring and imaging

“…In another study of extremely preterm neonates, the subjects with hemorrhage were found to have lower CBF when compared with those without hemorrhage (Lin et al , 2016). Similarly, lower CBF levels in neonates with hypoxic ischemic encephalopathy were reported, compared to age-matched healthy neonates (Dehaes et al , 2014).…”

“…DCS/DCT technologies have been extensively explored to be used in animal models and human subjects for the diagnosis and therapeutic monitoring of diseases in various tissues and organs including brains (Cheng et al , 2014; Hou et al , 2014; Busch et al , 2016a; Kim et al , 2014; Kim et al , 2010; Favilla et al , 2014; Lin et al , 2016; Dehaes et al , 2014; Durduran et al , 2010b; Shang et al , 2011b; Buckley et al , 2013; Zirak et al , 2014), skeletal muscles (Henry et al , 2015; Mesquita et al , 2013; Yu et al , 2005a; Shang et al , 2012; Gurley et al , 2012), and tumors (Chung et al , 2015; Choe et al , 2014; Zhou et al , 2007; Durduran et al , 2005; He et al , 2015; Sunar et al , 2006; Dong et al , 2012b; Dong et al , 2016). Since this review focuses on the clinical applications, only typical clinical examples are presented in the following subsections based on different types of tissues/organs.…”

“…Simultaneous measurements of tissue blood flow and blood oxygenation using combined DCS and NIRS instruments enable the evaluation of tissue metabolic rate of oxygen consumption (Durduran et al , 2004; Roche-Labarbe et al , 2010; Lin et al , 2016; Dehaes et al , 2014; Durduran et al , 2010b; Buckley et al , 2013; Henry et al , 2015; Shang et al , 2012; Gurley et al , 2012; Chung et al , 2015). This metabolic parameter is potentially a more direct indicator of tissue metabolic activities, which integrates many factors and provides further insight about tissue pathophysiology.…”

Accuracy and precision of tissue optical properties and hemodynamic parameters estimated by the BabyLux device: a hybrid time-resolved near-infrared and diffuse correlation spectroscopy neuro-monitor

“…red blood cells and a physical model can be utilized to relate this to a blood flow index (BFI) [15]. DCS has been validated against different standard techniques for blood flow measurement [16] and it has been employed in a variety of studies on infants [17][18][19][20][21][22].…”