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Relationship between cerebrovascular dysautoregulation and arterial blood pressure in the premature infant

Journal of Perinatology volume 31, pages 722–729 (2011)Cite this article

Subjects

Abstract

Objective:

To evaluate cerebrovascular autoregulation as a function of arterial blood pressure (ABP) in the critically ill, premature infant.

Study Design:

A prospective observational pilot study was conducted in two tertiary care Neonatal Intensive-Care Units. Premature infants (n=23, ⩽30 weeks estimated gestational age with invasive ABP monitoring) were enrolled and received routine care while undergoing continuous autoregulation monitoring, using the cerebral oximetry index (COx). The COx is a moving, linear correlation coefficient between cortical reflectance oximetry and ABP. COx values were stratified as a function of ABP for individual subject recordings and for the cohort.

Result:

The mean duration of autoregulation monitoring was 3.2 days (median: 2.97, range: 0.61–3.99). A total of 10 of 23 (43%) developed intraventricular hemorrhage and 1 of 23 (4%) developed periventricular leukomalacia by head ultrasound. No association was found between neurologic injury and percentage of the monitoring periods with autoregulation impairment (defined as COx>0.5). Lower ABP was associated with dysautoregulation (higher COx values, P<0.01). The percentage of time with impaired autoregulation was greater with lower ABP (P=0.013, Spearman r=0.51).

Conclusion:

All infants studied had periods with intact and periods with impaired cerebrovascular autoregulation, measured with the COx. Low ABP was associated with impaired autoregulation.

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Acknowledgements

Funding Support: Johns Hopkins Institute for Clinical and Translational Research—Accelerated translational incubator pilot program (ATIP) award (to K Brady), The Hartwell Foundation individual biomedical research award (to K Brady).

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Authors and Affiliations

  1. Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    M M Gilmore, J A Shepard, R B Easley & K M Brady

  2. Department of Pediatrics, Children's National Medical Center, Washington, DC, USA

    B S Stone

  3. Department of Academic Neurosurgery, Addenbrookes Hospital, University of Cambridge, Cambridge, UK

    M Czosnyka

  4. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    R B Easley & K M Brady

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  1. M M Gilmore
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Correspondence to K M Brady.

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Competing interests

The monitoring techniques described in this manuscript have been submitted for patent protection by Johns Hopkins University, listing K. Brady as inventor. Conflicts of interest related to these patents are managed by the Johns Hopkins University in accordance with its conflict of interest policies.

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Gilmore, M., Stone, B., Shepard, J. et al. Relationship between cerebrovascular dysautoregulation and arterial blood pressure in the premature infant. J Perinatol 31, 722–729 (2011). https://doi.org/10.1038/jp.2011.17

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