Relationship of Intravenous Sodium Bicarbonate Infusions and Cerebral Intraventricular Hemorrhage

Papile, Lu-Ann; Burstein, Jerome; Burstein, Rochelle; Koffler, Herbert; Koops, Beverly L.

doi:10.1097/00006254-197907010-00013

Cited by 17 publications

(18 citation statements)

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“…Multiple physiologic factors have been proposed as major or minor contributors to IVH, includng anoxia (16), increased arterial blood pressure and increased cerebral blood flow (23), decreased arterial pressure and ischemic brain injury (7), increased cerebral venous pressure (4), hyperosmolality (27), and coagulation defects (12). The most consistent feature of the hemorrhage is that it originates within the substance of the GM.…”

Section: Methodsmentioning

confidence: 99%

Regional Cerebral Blood Flow in the Newborn Beagle Pup: the Germinal Matrix is a “Low-Flow” Structure

et al. 1982

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SummaryThe newborn beagle pup serves as a model for neonatal intraventricular hemorrhage (IVH). Fluctuations in germinal matrix blood flow are felt to play a major role in the pathogenesis of IVH. We studied regional cerebral blood flow in awake newborn beagle pups utilizing [14CI-iodoantipyrine as a blood flow indicator and quantitative autoradiography. The equilibrium [tissue]:[bloodl partition coefficient for iodoantipyrine was 1.13 + .06 for grey matter.Blood flow was calculated for cerebral cortex (frontal = 59 + 9 m1/100 &in), 14 subcortical nuclear structures (e.g., caudate = 45 + 6 m1/100 g/min), 3 white matter structures (centrum semiovale = 7 + 1 m1/100 g/min), and germinal matrix (7 + 1 m1/100 g/ min) (mean + S.E.).We conclude that under normal physiologic conditions the germinal matrix receives relatively low blood flow. This information can be used for comparison with germinal matrix blood flow during adverse experimental conditions. Speculation wLow baseline blood flow may place the germinal matrix at risk for ischemic injury during hypoxic or hypotensive stress. This ischemic injury may be a critical step in the pathogenesis of intraventricular hemorrhage, either by disrupting vascular integrity or by producing a disproportionate increase in germinal matrix blood flow (luxury perfusion) after reestablishment of normoxemia and normotension.Increasing attention is being focused on the regulation of cerebral blood flow (CBF) in newborn infants. The pathophysiology of both perinatal asphyxia and neonatal intraventricular hemorrhage have been linked to fluctuations in CBF (25). Although quantitative studies of CBF in newborn infants have been performed (22,24,29, 35), these results are limited by the poor spatial resolution of the techniques. Recent advances have made it possible to accurately measure blood flow to small brain regions in unanesthetized animals (1 8,19,30). We set out to study the regulation of regional blood flow (rCBF) in newborn animals. We utilized the beagle puppy as our experimental animal because the newborn beagle has recently been established as an animal model for neonatal intraventricular hemorrhage (8,9). In this report, we present in detail our methods and rCBF values for normal, unanesthetized pups. MATERIALS AND METHODSRegional cerebral blood flow (rCBF) was studied in newborn (12-48 h old) purebred beagle pups (Laboratory Research Enterprises, Inc., Kalamazoo, MI) by the methods of Sakurada et al.(30). The pups were lightly anesthetized with nitrous oxide and halothane. Polyethylene catheters filled with 1.0 international units (IU) Na heparin per 1.0 cc 0.9% NaCl were inserted bilaterally into the femoral arteries and veins via skin incisions. The wounds were infiltrated with 2% lidocaine jelly (Astra Pharmaceutical Products, Worcester, MA) and the hind quarters of the animal wrapped in a cotton stocking and fast-setting plaster bandage (Johnson and Johnson Co, New Brunswick, NJ). The plaster cast was secured to a lead brick. The animals were able to move their head and...

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Section: Methodsmentioning

confidence: 99%

Regional Cerebral Blood Flow in the Newborn Beagle Pup: the Germinal Matrix is a “Low-Flow” Structure

et al. 1982

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“…Their immature brains and the presence of a fragile germinal matrix predispose them to development of intracranial hemorrhage after episodes of hypoxia or rapid changes in vascular pressure and osmolarity. 77,87,88 For this reason, avoid rapid boluses of volume expanders or hyperosmolar solutions.…”

Section: Prematuritymentioning

confidence: 99%

International Guidelines for Neonatal Resuscitation: An Excerpt From the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science

2000

Pediatrics

412

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The International Guidelines 2000 Conference on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC) formulated new evidenced-based recommendations for neonatal resuscitation. These guidelines comprehensively update the last recommendations, published in 1992 after the Fifth National Conference on CPR and ECC. As a result of the evidence evaluation process, significant changes occurred in the recommended management routines for: • Meconium-stained amniotic fluid: If the newly born infant has absent or depressed respirations, heart rate <100 beats per minute (bpm), or poor muscle tone, direct tracheal suctioning should be performed to remove meconium from the airway. • Preventing heat loss: Hyperthermia should be avoided. • Oxygenation and ventilation: 100% oxygen is recommended for assisted ventilation; however, if supplemental oxygen is unavailable, positive-pressure ventilation should be initiated with room air. The laryngeal mask airway may serve as an effective alternative for establishing an airway if bag-mask ventilation is ineffective or attempts at intubation have failed. Exhaled CO2 detection can be useful in the secondary confirmation of endotracheal intubation. • Chest compressions: Compressions should be administered if the heart rate is absent or remains <60 bpm despite adequate assisted ventilation for 30 seconds. The 2-thumb, encircling-hands method of chest compression is preferred, with a depth of compression one third the anterior-posterior diameter of the chest and sufficient to generate a palpable pulse. • Medications, volume expansion, and vascular access: Epinephrine in a dose of 0.01–0.03 mg/kg (0.1–0.3 mL/kg of 1:10,000 solution) should be administered if the heart rate remains <60 bpm after a minimum of 30 seconds of adequate ventilation and chest compressions. Emergency volume expansion may be accomplished with an isotonic crystalloid solution or O-negative red blood cells; albumin-containing solutions are no longer the fluid of choice for initial volume expansion. Intraosseous access can serve as an alternative route for medications/volume expansion if umbilical or other direct venous access is not readily available. • Noninitiation and discontinuation of resuscitation: There are circumstances (relating to gestational age, birth weight, known underlying condition, lack of response to interventions) in which noninitiation or discontinuation of resuscitation in the delivery room may be appropriate.

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“…The scans were repeated serially according to clinical conditions and at least every 5 or 6 days until a mean postmenstrual age of 40 weeks to check for IVH according to Perlman et al [26]. The occurrence of IVH was diagnosed according to Papile et al [27]. Ophthalmoscopic evaluations were scheduled in all infants with less than 32 weeks and in all who needed O2 therapy; checks were then repeated weekly until retinal maturation.…”

Section: Methodsmentioning

confidence: 99%

Free Radical-Related Diseases: The Predictive Value of Biomarkers in the Umbilical Cord Blood

Perrone¹,

Alagna²,

Cori³

et al. 2013

J Siena Acad Sci

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Abstract. Despite recent advances in preterm newborns healthcare, the incidence of neonatal pathologies and disabilities still remain unacceptable high. The deficiency of antioxidant systems and the high free radicals (FRs) production may cause several neonatal diseases, such as Retinopathy of Prematurity (ROP), Bronchopulmonary Dysplasia (BPD), Necrotizing Enterocolitis (NEC), Patent Ductus Arteriosus (PDA), Periventricular Leukomalacia (PVL) and Intraventricular Hemorrhage (IVH), representing facets of the 'Free Radical-Related Diseases' (FRD). The aim of this study is to verify the association between FRD and blood levels of reliable oxidative stress (OS) biomarkers in preterm newborns. We enrolled 178 preterm newborns born consecutively at the General Hospital "Santa Maria alle Scotte" in Siena, between 23 and 34 weeks (30,36±2.97) of gestational age, with birth-weight from 430 to 2890 grams (1453±593). After birth, we evaluated in the cord blood the markers of potential risk of OS (Non Protein-Bound Iron, NPBI) and the markers of FR damage (Total Hydroperoxides, TH; Advanced Oxidation Protein Products, AOPP). For each newborn, we assessed the presence or absence of the following diseases, considering as FRD the presence of one at least: ROP, BPD, NEC, PDA, PVL, IVH. The univariate logistic regression showed a significant association between FRD and OS related markers. Risk assessment of FRD was higher in newborns with higher values of each OS marker: respectively TH (OR=1.013, p=0,000), AOPP (OR=1.017, p=0,036), NPBI (OR=1.077, p=0.039). Perinatal OS exposure is linked to the main diseases of prematurity. The evaluation of OS biomarkers in preterm newborns through the analysis of umbilical cord blood, can be useful and predictive for early identification of infants at risk for FRD in order to devise appropriate and timely prevention and treating strategies.

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Relationship of Intravenous Sodium Bicarbonate Infusions and Cerebral Intraventricular Hemorrhage

Cited by 17 publications

References 0 publications

Regional Cerebral Blood Flow in the Newborn Beagle Pup: the Germinal Matrix is a “Low-Flow” Structure

Regional Cerebral Blood Flow in the Newborn Beagle Pup: the Germinal Matrix is a “Low-Flow” Structure

International Guidelines for Neonatal Resuscitation: An Excerpt From the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science

Free Radical-Related Diseases: The Predictive Value of Biomarkers in the Umbilical Cord Blood

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