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Zuiki M, Ohta M, Fujita N, Uda D, Uesugi M, Yamano A, Ichise E, Morimoto H, Hashiguchi K, Kinoshita D, Hasegawa T, Iehara T. The prediction of estimated cerebral perfusion pressure with trans-systolic time in preterm and term infants. Eur J Pediatr 2024; 183:2587-2595. [PMID: 38488878 DOI: 10.1007/s00431-024-05511-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/28/2024] [Accepted: 03/02/2024] [Indexed: 03/17/2024]
Abstract
It is important to monitor cerebral perfusion in infants because hypo- and hyperperfusion can contribute to neurological injury. This study aimed to clarify the relationship between trans-systolic time (TST) and critical closing pressure (CrCP) or estimated cerebral perfusion pressure (CPPe) in neonates. Moreover, we aimed to determine the TST values in preterm and term infants with stable cerebral perfusion to clarify normative reference data. This multicentre prospective study included infants with arterial lines admitted to the neonatal intensive care units between December 2021 and August 2023. TST, CrCP, and CPPe were calculated using middle cerebral artery waveforms recorded using transcranial Doppler ultrasonography when clinicians collected arterial blood samples. Three hundred and sixty samples were obtained from 112 infants with a gestational age of 32 (interquartile range, 27-37) weeks and a birth weight of 1481 (956-2355) g. TST was positively correlated with CPPe (r = 0.60, p < 0.001), but not with CrCP (r = 0.08, p = 0.10). The normative reference values of TST in preterm and term infants without samples of hyper- or hypocapnia and/or hyper- or hypotension, which may affect cerebral perfusion, were as follows: ≤ 29 weeks, 0.12 (0.11-0.14) s; 30-36 weeks, 0.14 (0.12-0.15) s; and ≥ 37 weeks, 0.16 (0.14-0.17) s, respectively. Conclusion: TST in neonates significantly correlated with CPPe, but not with CrCP. TST may be a good predictor of cerebral perfusion and potentially have wider clinical applications. What is Known: • Trans-systolic time (TST) is used in evaluating the effects of increased intracranial pressure on cerebral haemodynamics. However, little is known about the efficacy of TST in predicting neonatal cerebral perfusion pressure. What is New: • This study added evidence that TST correlated with estimated cerebral perfusion pressure, but not with critical closing pressure. Additionally, we showed the normative reference values of the TST in preterm and term infants.
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Affiliation(s)
- Masashi Zuiki
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi-Hirokoji, Kamigyoku, Kyoto, Japan.
| | - Mikito Ohta
- Department of Neonatology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Naoe Fujita
- Department of Pediatrics, National Hospital Organization Maizuru Medical Center, Kyoto, Japan
| | - Daisuke Uda
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi-Hirokoji, Kamigyoku, Kyoto, Japan
| | - Madoka Uesugi
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi-Hirokoji, Kamigyoku, Kyoto, Japan
| | - Akio Yamano
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi-Hirokoji, Kamigyoku, Kyoto, Japan
| | - Eisuke Ichise
- Department of Pediatrics, National Hospital Organization Maizuru Medical Center, Kyoto, Japan
| | - Hidechika Morimoto
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi-Hirokoji, Kamigyoku, Kyoto, Japan
| | - Kanae Hashiguchi
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi-Hirokoji, Kamigyoku, Kyoto, Japan
| | - Daisuke Kinoshita
- Department of Neonatology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Tatsuji Hasegawa
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi-Hirokoji, Kamigyoku, Kyoto, Japan
| | - Tomoko Iehara
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi-Hirokoji, Kamigyoku, Kyoto, Japan
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Jiang L, Yu Q, Wang F, Wu M, Liu F, Fu M, Gao J, Feng X, Zhang L, Xu Z. The role of blood pressure variability indicators combined with cerebral blood flow parameters in predicting intraventricular hemorrhage in very low birth weight preterm infants. Front Pediatr 2023; 11:1241809. [PMID: 37876522 PMCID: PMC10590921 DOI: 10.3389/fped.2023.1241809] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/22/2023] [Indexed: 10/26/2023] Open
Abstract
Background Hemodynamic instability is the main factor responsible for the development of intraventricular hemorrhage (IVH) in premature newborns. Herein, we evaluated the predictive ability of blood pressure variability (BPV) and anterior cerebral artery (ACA) blood flow parameters in IVH in premature infants with gestational age (GA) ≤32 weeks and birth weight (BW) ≤ 1,500 g. Methods Preterm infants with GA ≤32 weeks and BW ≤ 1,500 g admitted to the neonatal intensive care unit (NICU) of the hospital affiliated to Yangzhou University from January 2020 to January 2023 were selected as the research subjects. All preterm infants were admitted within 1 h after birth, and systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MABP) were monitored at 1-h intervals. The difference between maximum and minimum values (max-min), standard deviation (SD), coefficient of variation (CV), and successive variation (SV) were used as BPV indicators. On the 1st, 3rd, and 7th day after birth, transcranial ultrasound examination was performed to screen for the occurrence of IVH. On the 24 ± 1 h after birth, systolic velocity (Vs), diastolic velocity (Vd), and resistance index (RI) of the ACA were measured simultaneously. Preterm infants were divided into the IVH group and non-IVH group based on the results of transcranial ultrasound examination, and the correlation between BPV indicators, ACA blood flow parameters, and development of IVH was analyzed. Results A total of 92 premature infants were enrolled, including 49 in the IVH group and 43 in the non-IVH group. There was no statistically significant difference in baseline characteristics such as BW, GA, sex, and perinatal medical history between the two groups of preterm infants (P > 0.05). The SBP SD (OR: 1.480, 95%CI: 1.020-2.147) and ACA-RI (OR: 3.027, 95%CI: 2.769-3.591) were independent risk factors for IVH in premature newborns. The sensitivity and specificity of combined detection of SBP SD and ACA-RI in predicting IVH were 61.2% and 79.1%, respectively. Conclusion High BPV and ACA-RI are related to IVH in premature infants with GA ≤32 w and BW ≤1,500 g. Combined detection of SBP SD and ACA-RI has a certain predictive effect on early identification of IVH.
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Affiliation(s)
- Lijun Jiang
- Department of Neonatology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Qian Yu
- Department of Neonatology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Fudong Wang
- Department of Neonatology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Mingfu Wu
- Department of Neonatology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Feng Liu
- Department of Neonatology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Mingfeng Fu
- Department of Neonatology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Junyan Gao
- Department of Neonatology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Xing Feng
- Department of Neonatology, Affiliated Children's Hospital of Soochow University, Suzhou, China
| | - Longfeng Zhang
- Department of Clinical Laboratory, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Zhenxing Xu
- Department of Neonatology, Affiliated Hospital of Yangzhou University, Yangzhou, China
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Pereira SS, Sinha AK, Shah DK, Kempley ST. Cardiovascular changes following cerebral blood flow measurements using Doppler ultrasound in extremely preterm infants. Acta Paediatr 2022; 111:2098-2099. [PMID: 35766125 DOI: 10.1111/apa.16470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/07/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Sujith S Pereira
- Neonatal Unit, Homerton University Hospital, Homerton Healthcare NHS Foundation Trust, London, UK.,Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ajay K Sinha
- Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Neonatal Unit, Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Divyen K Shah
- Neonatal Unit, Royal London Hospital, Bart's Health NHS Trust, London, UK.,Centre for Neuroscience and Trauma, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Stephen T Kempley
- Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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