PEDIATRICS Vol. 106 No. 4 October 2000, pp. 625-632
Cerebral Intravascular Oxygenation Correlates With Mean Arterial Pressure in Critically Ill Premature Infants
Received Mar 8, 2000; accepted Jun 22, 2000.
,,
From the * Joint Program in Neonatology, Harvard Medical School,
Boston, Massachusetts; and the Departments of Cardiology and
§ Neurology, Children's Hospital and Harvard Medical School, Boston,
Massachusetts.
Objectives. Premature infants experience brain injury, ie, germinal matrix-intraventricular hemorrhage (GMH-IVH) and periventricular leukomalacia (PVL), in considerable part because of disturbances in cerebral blood flow (CBF). Because such infants are susceptible to major fluctuations in mean arterial blood pressure (MAP), impaired cerebrovascular autoregulation would increase the likelihood for the changes in CBF that could result in GMH-IVH and PVL. The objectives of this study were to determine whether a state of impaired cerebrovascular autoregulation could be identified reliably and conveniently at the bedside, the frequency of any such impairment, and the relation of the impairment to the subsequent occurrence of severe GMH-IVH and PVL.
Patients and Methods. To monitor the cerebral circulation
continuously and noninvasively, we used near-infrared spectroscopy
(NIRS) to determine quantitative changes in cerebral concentrations of
oxygenated hemoglobin (HbO2) and deoxygenated hemoglobin
(Hb) from the first hours of life. Our previous experimental study
showed a strong correlation between a measure of cerebral intravascular
oxygenation (HbD), ie, HbD = HbO2 
Hb, determined by
NIRS, and volemic CBF, determined by radioactive microspheres. We
studied 32 very low birth weight premature infants (gestational age:
23-31 weeks; birth weight: 605-1870 g) requiring mechanical
ventilation, supplemental oxygen, and invasive blood pressure
monitoring by NIRS from 1 to 3 days of age. MAP measured by arterial
catheter pressure transducer and arterial oxygen saturation measured by
pulse oximetry were recorded simultaneously. The relationship of MAP to
HbD was quantitated by coherence analysis.
Results. Concordant changes (coherence scores >.5) in HbD and MAP, consistent with impaired cerebrovascular autoregulation, were observed in 17 of the 32 infants (53%). Eight of the 17 infants (47%) developed severe GMH-IVH or PVL or both. Of the 15 infants with apparently intact autoregulation, ie, coherence scores <.5, only 2 (13%) developed severe ultrasonographic lesions. Thus, for the entire study population of 32 infants, 8 of the 10 with severe lesions exhibited coherence scores >.5.
Conclusions. We conclude that NIRS can be used in a noninvasive manner at the bedside to identify premature infants with impaired cerebrovascular autoregulation, that this impairment is relatively common in such infants, and that the presence of this impairment is associated with a high likelihood of occurrence of severe GMH-IVH/PVL. Key words: near-infrared spectroscopy, cerebrovascular autoregulation, prematurity, intraventricular hemorrhage, periventricular leukomalacia.
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