Published online October 17, 2008
PEDIATRICS Vol. 122 No. 5 November 2008, pp. e1006-e1013 (doi:10.1542/10.1542/peds.2008-0768)
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ARTICLE

Cerebral Hemodynamic Changes During Intensive Care of Preterm Infants

Catherine Limperopoulos, PhDa,b, Kimberlee K. Gauvreau, ScDc, Heather O'Leary, BScb, Marianne Moore, BA, RNb, Haim Bassan, MDb, Eric C. Eichenwald, MDd, Janet S. Soul, MDb, Steven A. Ringer, MD, PhDd, Donald N. Di Salvo, MDe and Adré J. du Plessis, MBChB, MPHb

a Department of Neurology and Neurosurgery and School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
b Fetal-Neonatal Neurology Research Group, Department of Neurology, and Departments of
c Pediatrics
e Radiology, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts
d Department of Newborn Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts

OBJECTIVES. The objectives of this study were to examine the circulatory changes experienced by the immature systemic and cerebral circulations during routine events in the critical care of preterm infants and to identify clinical factors that are associated with greater hemodynamic-oxygenation changes during these events.

METHODS. We studied 82 infants who weighed <1500 g at birth and required intensive care management and continuous blood pressure monitoring from an umbilical arterial catheter. Continuous recording of cerebral and systemic hemodynamic and oxygenation changes was performed. We studied 6 distinct types of caregiving events during 10-minute epochs: (1) quiet baseline periods; (2) minor manipulation; (3) diaper changes; (4) endotracheal tube suctioning; (5) endotracheal tube repositioning; and (6) complex events. Each event was matched with a preceding baseline. We examined the effect of specific clinical factors and cranial ultrasound abnormalities on the systemic and cerebral hemodynamic oxygenation changes that were associated with the various event types.

RESULTS. There were highly significant differences in hemodynamics and oxygenation between events overall and baseline epochs. The magnitude of these circulatory changes was greatest during endotracheal tube repositioning and complex caregiving events. Lower gestational age, higher illness severity, chorioamnionitis, low Apgar scores, and need for pressor-inotropes all were associated with circulatory changes of significantly lower magnitude. Cerebral hemodynamic changes were associated with early parenchymal ultrasound abnormalities.

CONCLUSIONS. Routine caregiving procedures in critically ill preterm infants are associated with major circulatory fluctuations that are clinically underappreciated and underdetected by current bedside monitoring. Our data underscore the importance of continuous cerebral hemodynamic monitoring in critically ill preterm infants.

Key Words: prematurity • cerebral hemodynamics • systemic hemodynamics • brain injury

Abbreviations: MAP—mean arterial blood pressure • NIRS—near-infrared spectroscopy • HbO2—oxyhemoglobin • Hb—deoxyhemoglobin • SaO2—oxyhemoglobin saturation • ET—endotracheal tube • HbD—hemoglobin difference signal • HbT—total hemoglobin • SNAP-II—Score for Neonatal Acute Physiology II • GM-IVH—germinal matrix–intraventricular hemorrhage

Accepted Jul 21, 2008.


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eLetters:

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Cerebral Hemodynamic Changes During Intensive Care of Preterm Infants: Impact of developmental care.
Jacques Sizun, et al.
Pediatrics Online, 5 Nov 2008 [Full text]