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Changes in hemodynamics, cerebral oxygenation and cerebrovascular reactivity during the early transitional circulation in preterm infants



Changes in systemic and cerebral hemodynamics in preterm infants during early transitional circulation are complex and may differ between infants with or without intraventricular hemorrhage (IVH).


In total, 43 infants born at median (range) 25 + 5 (23 + 3–31) had continuous near-infrared spectroscopy (NIRS) monitoring of tissue oxygenation index (TOI) and cerebrovascular reactivity within the first 48 h of life. Measurements of left and right cardiac outputs (LVO, RVO) and patent ductus arteriosus (PDA) were collected at 6, 12, 24, and 48 h of life.


LVO increased within the first 48 h in the IVH (P = 0.007) and no-IVH (P < 0.001) groups. The pattern of change in LVO and RVO was not different between these two groups. TOI was lower in the IVH (P < 0.001) group. A positive correlation between TOI and LVO (P = 0.003) and a negative correlation between the tissue oxygen reactivity index (TOx) and LVO (P = 0.04) were observed at 24 h of life in the IVH group. PDA diameter was not different between IVH groups at any time interval.


Cerebral oxygenation was lower and cerebrovascular reactivity was passive to systemic blood flow at 24 h in infants who developed an IVH.

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Financial support

SPARKS charity (11CUH02); Cambridge Trust and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) (PhD scholarship to Dr. Sortica da Costa/9418–11–3).

Author information

Substantial contributions to conception and design of the research work: C.S.da.C., Z.M., M.C., P.S. and T.A. Acquisition of data or analysis, and interpretation of data: C.S.da.C., D.C., I.Ng., Z.M. and W.K. Drafting the article: C.S.da.C. Revising the article critically for important intellectual content: D.C., Z.M., I.Ng., W.K., M.C., P.S. and T.A. Final approval of the version to be published: all authors.

Competing interests

The ICM+® software (ICM+; used for data monitoring and analysis is licensed by the Cambridge Enterprise Limited (University of Cambridge). Dr. Peter Smielewski and Professor Marek Czosnyka have an interest in a fraction of the licensing fee. The other authors have no conflicts of interests to disclosure.

Correspondence to Cristine Sortica da Costa.

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