C J Rhee1, C D Fraser2, K Kibler3, R B Easley3, D B Andropoulos3, M Czosnyka4, G V Varsos4, P Smielewski4, C G Rusin5, K M Brady3, J R Kaiser6. 1. Department of Pediatrics, Section of Neonatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA. 2. University of Texas at Houston School of Medicine, Houston, TX, USA. 3. Departments of Pediatrics and Anesthesiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA. 4. Division of Neurosurgery, Addenbrooke's Hospital, Cambridge University, Cambridge, England. 5. Department of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA. 6. Departments of Pediatrics and Obstetrics and Gynecology, Section of Neonatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
Abstract
OBJECTIVE: To quantify cerebrovascular autoregulation as a function of gestational age (GA) and across the phases of the cardiac cycle. STUDY DESIGN: The present study is a hypothesis-generating re-analysis of previously published data. Premature infants (n=179) with a GA range of 23 to 33 weeks were monitored with umbilical artery catheters and transcranial Doppler insonation of the middle cerebral artery for 1-h sessions over the first week of life. Autoregulation was quantified by three methods, as a moving correlation coefficient between: (1) systolic arterial blood pressure (ABP) and systolic cerebral blood flow (CBF) velocity (Sx); (2) mean ABP and mean CBF velocity (Mx); and (3) diastolic ABP and diastolic CBF velocity (Dx). Comparisons of individual and cohort cerebrovascular pressure autoregulation were made across GA for each aspect of the cardiac cycle. RESULTS: Systolic, mean and diastolic ABP increased with GA (r=0.3, 0.4 and 0.4; P<0.0001). Systolic CBF velocity was pressure-passive in infants with the lowest GA, and Sx decreased with advancing GA (r=-0.3; P<0.001), indicating increased capacity for cerebral autoregulation during systole during development. By contrast, Dx was elevated, indicating dysautoregulation, in all subjects and showed minimal change with advancing GA (r=-0.06; P=0.05). Multivariate analysis confirmed that both GA (P<0.001) and 'effective cerebral perfusion pressure' (ABP minus critical closing pressure (CrCP); P<0.01) were associated with Sx. CONCLUSION: Premature infants have low and usually pressure-passive diastolic CBF velocity. By contrast, the regulation of systolic CBF velocity by pressure autoregulation developed in this cohort between 23 and 33 weeks GA. Elevated effective cerebral perfusion pressure derived from the CrCP was associated with dysautoregulation.
OBJECTIVE: To quantify cerebrovascular autoregulation as a function of gestational age (GA) and across the phases of the cardiac cycle. STUDY DESIGN: The present study is a hypothesis-generating re-analysis of previously published data. Premature infants (n=179) with a GA range of 23 to 33 weeks were monitored with umbilical artery catheters and transcranial Doppler insonation of the middle cerebral artery for 1-h sessions over the first week of life. Autoregulation was quantified by three methods, as a moving correlation coefficient between: (1) systolic arterial blood pressure (ABP) and systolic cerebral blood flow (CBF) velocity (Sx); (2) mean ABP and mean CBF velocity (Mx); and (3) diastolic ABP and diastolic CBF velocity (Dx). Comparisons of individual and cohort cerebrovascular pressure autoregulation were made across GA for each aspect of the cardiac cycle. RESULTS: Systolic, mean and diastolic ABP increased with GA (r=0.3, 0.4 and 0.4; P<0.0001). Systolic CBF velocity was pressure-passive in infants with the lowest GA, and Sx decreased with advancing GA (r=-0.3; P<0.001), indicating increased capacity for cerebral autoregulation during systole during development. By contrast, Dx was elevated, indicating dysautoregulation, in all subjects and showed minimal change with advancing GA (r=-0.06; P=0.05). Multivariate analysis confirmed that both GA (P<0.001) and 'effective cerebral perfusion pressure' (ABP minus critical closing pressure (CrCP); P<0.01) were associated with Sx. CONCLUSION: Premature infants have low and usually pressure-passive diastolic CBF velocity. By contrast, the regulation of systolic CBF velocity by pressure autoregulation developed in this cohort between 23 and 33 weeks GA. Elevated effective cerebral perfusion pressure derived from the CrCP was associated with dysautoregulation.
Authors: Luzius A Steiner; Marek Czosnyka; Stefan K Piechnik; Piotr Smielewski; Doris Chatfield; David K Menon; John D Pickard Journal: Crit Care Med Date: 2002-04 Impact factor: 7.598
Authors: Christopher J Rhee; Cristine Sortica da Costa; Topun Austin; Ken M Brady; Marek Czosnyka; Jennifer K Lee Journal: Pediatr Res Date: 2018-09-08 Impact factor: 3.756
Authors: Eun Sun Kim; Jeffrey R Kaiser; Danielle R Rios; Renee A Bornemeier; Christopher J Rhee Journal: Neonatology Date: 2020-05-20 Impact factor: 4.035
Authors: Lana Vasung; Esra Abaci Turk; Silvina L Ferradal; Jason Sutin; Jeffrey N Stout; Banu Ahtam; Pei-Yi Lin; P Ellen Grant Journal: Neuroimage Date: 2018-07-21 Impact factor: 6.556
Authors: Christopher J Rhee; Charles D Fraser; Kathleen Kibler; Ronald B Easley; Dean B Andropoulos; Marek Czosnyka; Georgios V Varsos; Peter Smielewski; Craig G Rusin; Ken M Brady; Jeffrey R Kaiser Journal: Pediatr Res Date: 2015-03-31 Impact factor: 3.756
Authors: Zachary A Vesoulis; Steve M Liao; Shamik B Trivedi; Nathalie El Ters; Amit M Mathur Journal: Pediatr Res Date: 2015-11-16 Impact factor: 3.756