PEDIATRICS Vol. 85 No. 2 February 1990, pp. 172-176
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Increased Cerebral Blood Flow and Plasma Epinephrine in Hypoglycemic, Preterm Neonates

O. Pryds MD1, N. J. Christensen PhD1, and B. Friis-Hansen PhD1

1 From the Department of Neonatology, State University Hospital, Copenhagen, and the Department of Internal Medicine and Endocrinology, Herlev Hospital, Copenhagen, Denmark

Cerebral blood flow, plasma epinephrine, and plasma norepinephrine were measured in 25 spontaneously breathing, preterm neonates (mean gestational age 30.4 weeks) 2 hours after birth, during a routine screening for low blood glucose levels. Increased cerebral blood flow and plasma epinephrine values were observed when blood glucose levels were low, whereas plasma norepinephrine was constant throughout the blood glucose range. Hypoglycemia (defined as blood glucose concentration <30 mg/dL) was found in 13 neonates who were treated with intravenous glucose and milk enterally. Blood glucose levels were normal in the remaining 12 control neonates who received milk by a gastric line. Approximately 30 minutes after treatment with intravenous glucose and/or milk, cerebral blood flow had decreased by a mean of 11.3% in the 13 hypoglycemic neonates but was still 37.5% higher than cerebral blood flow in the control neonates despite normalization of plasma epinephrine concentration. Mean arterial blood pressure and blood gas values were identical between groups throughout the investigation. It is suggested that a normal coupling between cerebral metabolic demands and flow is present in very preterm neonates and that epinephrine may play a role in the cerebral hyperperfusion. Although none of the neonates had clinical signs of hypoglycemia, the data suggest that counterregulatory mechanisms are invoked when blood glucose values are <30 to 45 mg/dL.

Key Words: hypoglycemia • cerebral blood flow • plasma epinephrine • plasma norepinephrine • preterm neonate

Submitted on December 7, 1988
Accepted on April 3, 1989




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