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PEDIATRICS Vol. 109 No. 3 March 2002, pp. 434-440

Noninvasive Continuous Monitoring of the Effects of Head Position on Brain Hemodynamics in Ventilated Infants

Adelina Pellicer, MD*, Francisco Gayá, EE*,{ddagger}, Rosario Madero, MD*,{ddagger}, José Quero, MD* and Fernando Cabañas, MD*

* Department of Neonatology, La Paz University Hospital, Madrid, Spain
{ddagger} Research Unit, La Paz University Hospital, Madrid, Spain

--> Hypothesis. Laying supine with the head in midline position improves cerebral venous return by preventing functional occlusion of the vessels of the neck.

Objectives. To assess changes in cerebral blood volume ({Delta}CBV) and cerebral blood flow (CBF) with the position of the head in ventilated patients using a noninvasive method. The influence of the type of ventilation and birth weight was evaluated.

Methods. Thirteen conventionally ventilated and 8 high-frequency oscillatory ventilated infants, with mean gestational ages and birth weights of 31 ± 5 weeks (24–38) and 1575 ± 803 g (560–3000), respectively, were studied 5.8 ± 7.8 days (1–33) after birth. {Delta}CBV (mL/100 g) and CBF (mL/100 g/min) were measured by near-infrared spectroscopy with the head in supine midline position ({Delta}CBVs, CBFs) and rotated 90° to one side ({Delta}CBVlat, CBFlat). Heart rate, peripheral saturation, transcutaneous PCO2, and blood pressure were monitored continuously. Ventilatory settings remained constant throughout the study period.

Results. Mean {Delta}CBVs was lower than mean {Delta}CBVlat, although no changes in blood pressure, transcutaneous PCO2, oxygenation, or heart rate occurred. This change in {Delta}CBV was not associated with the type of ventilation or birth weight, but the differences tended to be greater (d{Delta}CBV = {Delta}CBVlat-{Delta}CBVs) in the smallest infants (<1200 g). In contrast, CBF did not vary.

Conclusion. The supine midline position of the head favors cerebral venous drainage and helps to prevent elevation of CBV.

Speculation. This finding may be important in the first days of life, particularly in tiny preterm infants recovering from lung disease with improving lung compliance, in which functional obstruction of cerebral venous drainage should be avoided.

Key Words: neonate • cerebral blood volume • cerebral blood flow • head position • mechanical ventilation • near-infrared spectroscopy

Abbreviations: CBF, cerebral blood flow • CBV, cerebral blood volume • {Delta}CBV, changes in cerebral blood volume • SaO2, arterial oxygen saturation • NIRS, near-infrared spectroscopy • O2Hb, oxyhemoglobin • HHb, deoxyhemoglobin • {Delta}THb, changes in total hemoglobin • {Delta}CBVlat, changes in cerebral blood volume with the head rotated 90° to one side • {Delta}CBVs, changes in cerebral blood volume with the head in supine midline position • d{Delta}CBV, difference in cerebral blood volume changes with the head rotated 90° to the side as compared with the midline position

Received for publication Feb 5, 2001; Accepted Jul 2, 2001.




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