Cerebral Blood Flow Velocities in Extremely Low Birth Weight Infants with Hypotension and Infants with Normal Blood Pressure
Presented in part at the Pediatric Academic Society, Society for Pediatric Research meeting, Toronto, Canada, May 5–8, 2007.
Received 16 October 2008; received in revised form 8 December 2008; accepted 6 January 2009. published online 26 March 2009.
Objective
To determine whether extremely low birth weight (ELBW) infants with hypotension have similar cerebral hemodynamics when compared with control subjects with normal blood pressure. We hypothesized that ELBW infants with low or normal blood pressure have similar cerebral blood flow (CBF) velocity.
Study design
In this case control study, CBF velocity (with Doppler ultrasound scanning), Pco2, and mean arterial blood pressure (MABP) were continuously monitored twice daily before intensive care procedures. If an infant became hypotensive (MABP ≤ gestational age in weeks), additional monitoring was performed for 10 to 20 minutes, before treatment with dopamine. Thirty ELBW infants were enrolled (637 ± 140 g, 24.2 ± 1.1 weeks); 15 had hypotension, and 15 were gestational age/birth weight–matched control subjects with normal blood pressure. CBF velocity was compared by use of the Mann-Whitney U test.
Results
The groups did not differ significantly in gestational age, birth weight, race, sex, Pco2, Apgar scores, or occurrence of severe intraventricular hemorrhage. There was no difference in mean CBF velocity (P = .934) in infants with hypotension (MABP: 23 [20-24.9] mm Hg) compared with infants with normal blood pressure (MABP: 32.6 [27.5-35.7] mm Hg).
Conclusion
Despite having hypotension, ELBW infants (before treatment) had similar CBF velocity compared with control subjects with normal blood pressure. On the basis of these results, hypotension may not indicate decreased CBF.
aDepartment of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
bDepartment of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR
cDepartment of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
Reprint requests: Jeffrey R. Kaiser, MD, MA, 800 Marshall St, Slot 512, Little Rock, AR 72202
M.L. was supported by an intramural grant from Children's University Medical Group. J.K. was supported by the National Institutes of Health (1 K23 NS43185, RR20146, and M01RR14288). The authors declare no conflicts of interest.
ABSTRACT