The ontogeny of cerebrovascular pressure autoregulation in premature infants

Christopher J. Rhee*, Charles D. Fraser, Kathleen Kibler, Ronald B. Easley, Dean B. Andropoulos, Marek Czosnyka, Georgios V. Varsos, Peter Smielewski, Craig G. Rusin, Kenneth Martin Brady, Jeffrey R. Kaiser

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Our objective was to quantify cerebrovascular autoregulation as a function of gestational age (GA) and across the phases of the cardiac cycle. One hundred eightysix premature infants, with a GA range of 23-33 weeks, were monitored using umbilical artery catheters and transcranial Doppler insonation of middle cerebral artery flow velocity (FV) for 1-h sessions over the first week of life. Autoregulation was quantified as a moving correlation coefficient between systolic arterial blood pressure (ABP) and systolic FV (Sx); mean ABP and mean FV (Mx); diastolic ABP and diastolic FV (Dx). Autoregulation was compared across GAs for each aspect of the cardiac cycle. Systolic FV was pressure-passive in infants with the lowest GA, and Sx decreased with increased GA (r = -0.3; p < 0.001). By contrast, Dx was elevated in all subjects, and showed minimal change with increased GA (r = -0.06; p = 0.05). Multivariate analysis confirmed that GA (p < 0.001) and the "closing margin" (p < 0.01) were associated with Sx. Premature infants have low and almost always pressure-passive diastolic cerebral blood FV. Conversely, the regulation of systolic cerebral blood FV by autoregulation was manifested in this cohort at a GA of between 23 and 33 weeks.

Original languageEnglish (US)
Pages (from-to)151-155
Number of pages5
JournalActa Neurochirurgica, Supplementum
Volume122
DOIs
StatePublished - 2016

Keywords

  • Arterial blood pressure
  • Cerebrovascular pressure autoregulation
  • Closing margin
  • Prematurity

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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