Published online February 5, 2007
PEDIATRICS Vol. 119 No. 3 March 2007, pp. e610-e615 (doi:10.1542/peds.2006-2110)
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ARTICLE

Early Childhood Gender Differences in Anterior and Posterior Cerebral Blood Flow Velocity and Autoregulation

Nuj Tontisirin, MDa, Saipin L. Muangman, MDa, Pilar Suz, MDa, Catherine Pihoker, MDb, Dana Fisk, RNb, Anne Moore, RVTd, Arthur M. Lam, MDc,d and Monica S. Vavilala, MDa,b,c,d

a Anesthesiology
b Pediatrics
c Neurological Surgery, University of Washington, Seattle, Washington
d Cerebrovascular Laboratory, Harborview Medical Center, Seattle, Washington

OBJECTIVE. We aimed to describe gender differences in blood flow velocity and autoregulation of the anterior and posterior cerebral circulations in prepubertal children.

METHODS. A prospective observational cohort study was performed at Harborview Medical Center's Cerebrovascular Laboratory after institutional review board approval, consent, and assent procedures. Children underwent measurement of middle cerebral and basilar artery flow velocities and cerebral autoregulation testing of the middle cerebral and basilar arteries. Cerebral autoregulation was quantified using the autoregulatory index, and estimated cerebrovascular resistance was calculated. Autoregulatory index <0.4 reflects impaired cerebral autoregulation. Data are presented as mean ± SD. Patients were healthy 4- to 8-year-old children.

RESULTS. Forty-eight children (24 boys and 24 girls) 4 to 8 years of age (mean: 6 ± 2 years) were enrolled. Middle cerebral artery flow velocity was higher than basilar artery flow velocity (96 ± 13 vs 65 ± 11 cm/s). Girls had higher middle cerebral artery flow velocity (99 ± 11 vs 91 ± 13 cm/s) and basilar artery flow velocity (70 ± 10 vs 61 ± 9 cm/s) than boys. Cerebral autoregulation was intact in all children. There was no gender difference in autoregulation between the middle cerebral artery (boys: 0.97 ± 0.07; girls: 0.94 ± 0.11) or basilar artery (boys: 0.94 ± 0.13; girls: 0.94 ± 0.11).

CONCLUSIONS. Similar to older children and adults, girls between 4 and 8 years of age had higher middle cerebral and basilar artery flow velocity than age-matched boys. This difference may reflect inherent differences in cerebral metabolic rate and/or estimated cerebrovascular resistance between the genders.

Key Words: cerebral blood flow velocity • pediatrics • cerebral autoregulation

Abbreviations: CBF—cerebral blood flow • CBFV—cerebral blood flow velocity • TCD—transcranial Doppler • Vmca—middle cerebral artery flow velocity • BA—basilar artery • Vbas—basilar artery flow velocity • MCA—middle cerebral artery • MAP—mean arterial pressure • MAPe—estimated mean arterial pressure • eCVR—estimated cerebrovascular resistance • CVR—cerebrovascular resistance • ARI—autoregulatory index • ARImca—autoregulatory index for the middle cerebral artery • ARIbas—autoregulatory index for the basilar artery • CMR—cerebral metabolic rate • RI—resistance index

Accepted Sep 27, 2006.