The Journal of Pediatrics
Volume 154, Issue 6 , Pages 824-828 , June 2009

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.

  • Marla H. Lightburn, MD

      Affiliations

    • Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
  • ,
  • C. Heath Gauss, MS

      Affiliations

    • Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR
  • ,
  • D. Keith Williams, PhD

      Affiliations

    • Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR
  • ,
  • Jeffrey R. Kaiser, MD, MA

      Affiliations

    • Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
    • Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
    • Corresponding Author InformationReprint requests: Jeffrey R. Kaiser, MD, MA, 800 Marshall St, Slot 512, Little Rock, AR 72202

Received 16 October 2008 ,Revised 8 December 2008 ,Accepted 6 January 2009.

References 

  1. Fanaroff JM, Wilson-Costello DE, Newman NS, Montpetite MM, Fanaroff AA. Treated hypotension is associated with neonatal morbidity and hearing loss in extremely low birth weight infants. Pediatrics. 2006;117:1131–1135
  2. Watkins AM, West CR, Cooke RW. Blood pressure and cerebral haemorrhage and ischaemia in very low birthweight infants. Early Hum Dev. 1989;19:103–110
  3. Al-Aweel I, Pursley DM, Rubin LP, Shah B, Weisberger S, Richardson DK. Variations in prevalence of hypotension, hypertension, and vasopressor use in NICUs. J Perinatol. 2001;21:272–278
  4. Martens SE, Rijken M, Stoelhorst GMSJ, van Zwieten PHT, Zwinderman AH, Wit JM, et al. Is hypotension a major risk factor for neurological morbidity at term age in very preterm infants?. Early Hum Dev. 2003;75:79–89
  5. Watterberg KL, Gerdes JS, Cole CH, Aucott SW, Thilo EH, Mammel MC, et al. Prophylaxis of early adrenal insufficiency to prevent bronchopulmonary dysplasia: A multicenter trial. Pediatrics. 2004;114:1649–1657
  6. Joint Working Group of the British Association of Perinatal Medicine and the Research Unit of the Royal College of Physicians. Development of audit measures and guidelines for good practice in the management of neonatal respiratory distress syndrome. Arch Dis Child. 1992;67:1221–1227
  7. Miall-Allen VM, De Vries LS, Whitelaw AGL. Mean arterial blood pressure and neonatal cerebral lesions. Arch Dis Child. 1987;62:1068–1069
  8. Munro MJ, Walker AM, Barfield CP. Hypotensive extremely low birth weight infants have reduced cerebral blood flow. Pediatrics. 2004;114:1591–1596
  9. Dempsey EM, Barrington KJ. Diagnostic criteria and therapeutic interventions for the hypotensive very low birth weight infant. J Perinatol. 2006;26:677–681
  10. Laughon M, Bose C, Allred E, O'Shea TM, Van Marter LJ, Bednarek F, et al. Factors associated with treatment for hypotension in extremely low gestational age newborns during the first postnatal week. Pediatrics. 2007;119:273–280
  11. Osborn DA, Evans N. Early volume expansion versus inotrope for prevention of morbidity and mortality in very preterm infants. The Cochrane Library. 2006;1:1–14
  12. Limperopoulos C, Bassan H, Kalish LA, Ringer SA, Eichenwald EC, Walter G, et al. Current definitions of hypotension do not predict abnormal cranial ultrasound findings in preterm infants. Pediatrics. 2007;120:966–977
  13. Seri I, Abbasi S, Wood DC, Gerdes JS. Regional hemodynamic effects of dopamine in the sick preterm neonate. J Pediatr. 1998;133:728–734
  14. Synnes AR, Chien LY, Peliowski A, Baboolal R, Lee SK Canadian NICU Network. Variations in intraventricular hemorrhage incidence rates among Canadian neonatal intensive care units. J Pediatr. 2001;138:525–531
  15. Evans JR, Short BL, Van Meurs K, Sachs HC. Cardiovascular support in preterm infants. Clin Ther. 2006;28:1366–1384
  16. Tyszczuk L, Meek J, Elwell C, Wyatt JS. Cerebral blood flow is independent of mean arterial blood pressure in preterm infants undergoing intensive care. Pediatrics. 1998;102:337–341
  17. Jayasinghe D, Gill AB, Levene MI. CBF reactivity in hypotensive and normotensive preterm infants. Pediatr Res. 2003;54:848–853
  18. Kaiser JR, Gauss CH, Williams DK. Surfactant administration acutely affects cerebral and systemic hemodynamics and gas exchange in very low birth weight infants. J Pediatr. 2004;144:809–814
  19. Kaiser JR, Gauss CH, Williams DK. The effects of hypercapnia on cerebral autoregulation in ventilated very low birth weight infants. Pediatr Res. 2005;58:931–935
  20. Kaiser JR, Gauss CH, Williams DK. Tracheal suctioning is associated with prolonged disturbances of cerebral hemodynamics in very low birth weight infants. J Perinatol. 2008;28:34–41
  21. Pellicer A, Valverde E, Elorza MD, Madero R, Gayá F, Quero J, et al. Cardiovascular support for low birth weight infants and cerebral hemodynamics: A randomized, blinded, clinical trial. Pediatrics. 2005;115:1501–1512
  22. Bode H. Pediatric Applications of Transcranial Doppler Sonography. New York: Springer-Verlag; 1988;
  23. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: A study of infants with birth weights less than 1500 gm. J Pediatr. 1978;92:529–534
  24. Kluckow M, Evans N. Relationship between blood pressure and cardiac output in preterm infants requiring mechanical ventilation. J Pediatr. 1996;129:506–512
  25. Pladys P, Wodey E, Beuchée A, Branger B, Bétrémieux P. Left ventricle output and mean arterial blood pressure in preterm infants during the 1st day of life. Eur J Pediatr. 1999;158:817–824
  26. Greisen G, Johansen K, Ellison PH, Fredriksen PS, Mali J, Friis-Hansen B. Cerebral blood flow in the newborn infant: Comparison of Doppler ultrasound and 133xenon clearance. J Pediatr. 1984;104:411–418
  27. Haaland K, Karlsson B, Skovlund E, Lagercrantz H, Thoresen M. Postnatal development of the cerebral blood flow velocity response to changes in CO2 and mean arterial blood pressure in the piglet. Acta Paediatr. 1995;84:1414–1420
  28. Batton DG, Hellmann J, Hernandez MJ, Maisels MJ. Regional cerebral blood flow, cerebral blood velocity, and pulsatility index in newborn dogs. Pediatr Res. 1983;17:908–912
  29. Bassan H, Gauvreau K, Newburger JW, Tsuji M, Limperopoulos C, Soul JS, et al. Identification of pressure passive cerebral perfusion and its mediators after infant cardiac surgery. Pediatr Res. 2005;57:35–41
  30. Tsuji M, Du Plessis A, Taylor G, Crocker R, Volpe JJ. Near infrared spectroscopy detects cerebral ischemia during hypotension in piglets. Pediatr Res. 1998;44:591–595
  31. Pellicer A, Valverde E, Gayá F, Quero J, Cabañas F. Postnatal adaptation of brain circulation in preterm infants. Pediatr Neurol. 2001;24:103–109
  32. Mosca F, Bray M, Lattanzio M, Fumagalli M, Tosetto C. Comparative evaluation of the effects of indomethacin and ibuprofen on cerebral perfusion and oxygenation in preterm infants with patent ductus arteriosus. J Pediatr. 1997;131:549–554
  33. Perlman JM, McMenamin JB, Volpe JJ. Fluctuating cerebral blood-flow velocity in respiratory-distress syndrome (Relation to the development of intraventricular hemorrhage). N Engl J Med. 1983;309:204–209
  34. Barrington KJ, Dempsey EM. Cardiovascular support in the preterm: Treatments in search of indications. J Pediatr. 2006;148:289–291

 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.

PII: S0022-3476(09)00004-3

doi: 10.1016/j.jpeds.2009.01.006

The Journal of Pediatrics
Volume 154, Issue 6 , Pages 824-828 , June 2009