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Early arterial pressure monitoring and term-equivalent age MRI findings in very preterm infants

Pediatric Research volume 92, pages 822–828 (2022)Cite this article

Abstract

Introduction

Variability of arterial blood pressure (ABP) has been associated with intraventricular hemorrhage in very preterm neonates (VPT) and may predict other brain lesions assessed at term-equivalent of age (TEA).

Methods

This was a prospective single-center study including VPT with early invasive continuous ABP monitoring and assessed at TEA using brain magnetic resonance imaging (TEA-MRI). The association between early mean ABP (MABP) and TEA-MRI findings was modeled by multivariate logistic regression analysis using covariates selected by the LASSO method.

Results

Among 99 VPT, the LASSO procedure selected consecutive periods of lowest MABP of 30 min on day 1 (d1) and 10 min on day 2 (d2) as the most relevant durations to predict TEA-MRI findings (OR [95% CI], 1.11 [1.02–1.23], p = 0.03 and 1.13 [1.01–1.27], p = 0.03, respectively). ROC curve analysis showed optimal thresholds at 30.25 mmHg on d1 and 33.25 mmHg on d2. This significant association persisted after adjustment with covariates including birthweight, gestational age, sex, and inotrope exposure. Final models selected by LASSO included the decile of the birthweight and lowest MABP for 30 min on d1 and 10 min on d2, for which the areas under the ROC curve were 74% and 75%, respectively.

Conclusion

Early continuous ABP monitoring may predict brain TEA-MRI findings in VPT.

Impact

  • Early arterial blood pressure monitoring may contribute to predicting brain damage upon MRI at term-equivalent of age for infants born very preterm.

  • Careful blood pressure continuous monitoring in very preterm infants may identify infants at risk of long-term brain damage.

  • Umbilical artery catheterization provides the best option for continuously monitoring arterial blood pressure in very preterm infants.

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Fig. 1
Fig. 2: Trends in MABP values recorded during the first 72 postnatal hours in infants with normal (in blue) and abnormal (in red) TEA-MRI.
Fig. 3: Multivariable logistic regression analysis of the association between MABP and normal brain TEA-MRI.

References

  1. Pellicer, A., Valverde, E., Gaya, F., Quero, J. & Cabanas, F. Postnatal adaptation of brain circulation in preterm infants. Pediatr. Neurol. 24, 103–109 (2001).

    Article  CAS  Google Scholar 

  2. Miall-Allen, V. M., de Vries, L. S. & Whitelaw, A. G. Mean arterial blood pressure and neonatal cerebral lesions. Arch. Dis. Child. 62, 1068–1069 (1987).

    Article  CAS  Google Scholar 

  3. Watkins, A. M., West, C. R. & Cooke, R. W. Blood pressure and cerebral haemorrhage and ischaemia in very low birthweight infants. Early Hum. Dev. 19, 103–110 (1989).

    Article  CAS  Google Scholar 

  4. Huvanandana, J. et al. Prediction of intraventricular haemorrhage in preterm infants using time series analysis of blood pressure and respiratory signals. Sci. Rep. 7, 46538 (2017).

    Article  Google Scholar 

  5. Vesoulis, Z. A., Liao, S. M. & Mathur, A. M. Gestational age-dependent relationship between cerebral oxygen extraction and blood pressure. Pediatr. Res. 82, 934–939 (2017).

    Article  Google Scholar 

  6. Vesoulis, Z. A. et al. Blood pressure extremes and severe IVH in preterm infants. Pediatr. Res. 87, 69–73 (2020).

    Article  CAS  Google Scholar 

  7. Faust, K. et al. Short-term outcome of very-low-birthweight infants with arterial hypotension in the first 24 h of life. Arch. Dis. Child Fetal Neonatal Ed. 100, F388–F392 (2015).

    Article  Google Scholar 

  8. Batton, B. et al. Early blood pressure, antihypotensive therapy and outcomes at 18-22 months’ corrected age in extremely preterm infants. Arch. Dis. Child Fetal Neonatal Ed. 101, F201–F206 (2016).

    Article  Google Scholar 

  9. Parodi, A. et al. Cranial ultrasound findings in preterm germinal matrix haemorrhage, sequelae and outcome. Pediatr. Res. 87, 13–24 (2020).

    Article  Google Scholar 

  10. Volpe, J. J. The encephalopathy of prematurity–brain injury and impaired brain development inextricably intertwined. Semin. Pediatr. Neurol. 16, 167–178 (2009).

    Article  Google Scholar 

  11. Kidokoro, H., Neil, J. J. & Inder, T. E. New MR imaging assessment tool to define brain abnormalities in very preterm infants at term. AJNR Am. J. Neuroradiol. 34, 2208–2214 (2013).

    Article  CAS  Google Scholar 

  12. Belloni, A., Chernozhukov, V. & Hansen, C. Inference on treatment effects after selection amongst high-dimensional controls. Rev. Econ. Stud. 81, 608–650 (2014).

    Article  Google Scholar 

  13. Natalucci, G. et al. Effect of early prophylactic high-dose recombinant human erythropoietin in very preterm infants on neurodevelopmental outcome at 2 years: a randomized clinical trial. JAMA 315, 2079–2085 (2016).

    Article  CAS  Google Scholar 

  14. Vesoulis, Z. A., El Ters, N. M., Wallendorf, M. & Mathur, A. M. Empirical estimation of the normative blood pressure in infants <28 weeks gestation using a massive data approach. J. Perinatol. 36, 291–295 (2016).

    Article  CAS  Google Scholar 

  15. Inder, T. E., Wells, S. J., Mogridge, N. B., Spencer, C. & Volpe, J. J. Defining the nature of the cerebral abnormalities in the premature infant: a qualitative magnetic resonance imaging study. J. Pediatr. 143, 171–179 (2003).

    Article  Google Scholar 

  16. Miller, S. P. et al. Early brain injury in premature newborns detected with magnetic resonance imaging is associated with adverse early neurodevelopmental outcome. J. Pediatr. 147, 609–616 (2005).

    Article  Google Scholar 

  17. Pittet, M. P., Vasung, L., Huppi, P. S. & Merlini, L. Newborns and preterm infants at term equivalent age: a semi-quantitative assessment of cerebral maturity. Neuroimage Clin. 24, 102014 (2019).

    Article  Google Scholar 

  18. Bass, W. T. et al. Indices of hemodynamic and respiratory functions in premature infants at risk for the development of cerebral white matter injury. J. Perinatol. 22, 64–71 (2002).

    Article  Google Scholar 

  19. Giraud, A. et al. Perinatal inflammation is associated with social and motor impairments in preterm children without severe neonatal brain injury. Eur. J. Paediatr. Neurol. 28, 126–132 (2020).

    Article  Google Scholar 

  20. Dammann, O. & Leviton, A. Maternal intrauterine infection, cytokines, and brain damage in the preterm newborn. Pediatr. Res. 42, 1–8 (1997).

    Article  CAS  Google Scholar 

  21. Hagberg, H. & Mallard, C. Effect of inflammation on central nervous system development and vulnerability. Curr. Opin. Neurol. 18, 117–123 (2005).

    Article  CAS  Google Scholar 

  22. Furukawa, S., Sameshima, H. & Ikenoue, T. Circulatory disturbances during the first postnatal 24h in extremely premature infants 25 weeks or less of gestation with histological fetal inflammation. J. Obstet. Gynaecol. Res. 34, 27–33 (2008).

    PubMed  Google Scholar 

  23. Vesoulis, Z. A. & Mathur, A. M. Cerebral autoregulation, brain injury, and the transitioning premature infant. Front. Pediatr. 5, 64 (2017).

    Article  Google Scholar 

  24. Adams-Chapman, I. Long-term impact of infection on the preterm neonate. Semin. Perinatol. 36, 462–470 (2012).

    Article  Google Scholar 

  25. Patra, A., Huang, H., Bauer, J. A. & Giannone, P. J. Neurological consequences of systemic inflammation in the premature neonate. Neural Regen. Res. 12, 890–896 (2017).

    Article  Google Scholar 

  26. Prasad, J. D. et al. Coordinated microstructural disruptions of the developing neocortex and subcortical white matter after prolonged mild-to-moderate early postnatal systemic inflammation. Brain Behav Immun 94, 338–356 (2021).

    Article  Google Scholar 

  27. Volpe, J. J. Systemic inflammation, oligodendroglial maturation, and the encephalopathy of prematurity. Ann. Neurol. 70, 525–529 (2011).

    Article  Google Scholar 

  28. Huning, B. et al. Relationship between brain function (AEEG) and brain structure (MRI) and their predictive value for neurodevelopmental outcome of preterm infants. Eur. J. Pediatr. 177, 1181–1189 (2018).

    Article  Google Scholar 

  29. Durrmeyer, X. et al. Abstention or intervention for isolated hypotension in the first 3 days of life in extremely preterm infants: association with short-term outcomes in the Epipage 2 Cohort Study. Arch. Dis. Child Fetal Neonatal Ed. 102, 490–496 (2017).

    Article  Google Scholar 

  30. Dempsey, E. M. et al. Hypotension in preterm infants (HIP) randomised trial. Arch. Dis. Child Fetal Neonatal Ed. 106, 398–403 (2021).

    Article  Google Scholar 

Download references

Funding

This work was funded by Department of Pediatrics, University Hospitals, Geneva.

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Author notes

  1. These authors contributed equally: Alain Beuchée, Olivier Baud.

Authors and Affiliations

  1. Division of Neonatology and Pediatric Intensive Care, Children’s University Hospital of Geneva and University of Geneva, 1205, Geneva, Switzerland

    Roberta Butticci, Francisca Barcos-Munoz, Riccardo Pfister & Olivier Baud

  2. Pediatric Radiology Unit, Division of Radiology, Children’s University Hospital of Geneva and University of Geneva, 1211, Geneva, Switzerland

    Céline Habre & Sylviane Hanquinet

  3. University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, F-35000, Rennes, France

    Alfredo Hernandez & Alain Beuchée

  4. NeuroDiderot, UMR 1141, Inserm, Université de Paris, Paris, France

    Olivier Baud

Authors
  1. Roberta Butticci
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Contributions

Conception and design, acquisition of data, or analysis and interpretation of data: R.B., C.H., A.H., F.B.-M., S.H., A.B., and O.B. Drafting of the article or critical revision for important intellectual content: R.B., A.B., and O.B. Final approval of the version to be published: all.

Corresponding author

Correspondence to Olivier Baud.

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The authors declare no competing interests.

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A form providing written consent was collected from the parents of all patients at admission and the study was approved by the Swiss National Ethics Committee (BASEC No. 2018-00738).

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Butticci, R., Habre, C., Hernandez, A. et al. Early arterial pressure monitoring and term-equivalent age MRI findings in very preterm infants. Pediatr Res 92, 822–828 (2022). https://doi.org/10.1038/s41390-021-01839-2

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