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The ontogeny of cerebrovascular pressure autoregulation in premature infants

Journal of Perinatology volume 34, pages 926–931 (2014)Cite this article

Subjects

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.

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Acknowledgements

Dr Kaiser was supported by the National Institutes of Health (1K23NS43185, RR20146 and 1R01NS060674) and the University of Arkansas for Medical Sciences Translational Research Institute (1UL1RR029884). The technical assistance of Natalie C Sikes and Melanie J Mason and the support of the University of Arkansas for Medical Sciences neonatologists, NICU nurses, respiratory therapists and ultrasound technicians are gratefully appreciated.

AUTHOR CONTRIBUTIONS

Each author listed on this manuscript has seen and approved the submission of this version of the manuscripts and takes full responsibility for the manuscript. CJR conceptualized the reanalysis of the primary data, performed the data analysis, drafted the initial manuscript and reviewed and revised the manuscript. KK, RBE, DBA, MC, PS and CGR reviewed and revised the manuscript. GVV performed data analysis and reviewed and revised the manuscript. KMB performed data analysis, reviewed and revised the manuscript. JRK conceptualized and designed the initial study, collected the primary data, performed the data analysis and reviewed and revised the manuscript.

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Authors and Affiliations

  1. Department of Pediatrics, Section of Neonatology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA

    C J Rhee

  2. University of Texas at Houston School of Medicine, Houston, TX, USA

    C D Fraser III

  3. Departments of Pediatrics and Anesthesiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA

    K Kibler, R B Easley, D B Andropoulos & K M Brady

  4. Division of Neurosurgery, Addenbrooke’s Hospital, Cambridge University, Cambridge, England

    M Czosnyka, G V Varsos & P Smielewski

  5. Department of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA

    C G Rusin

  6. Departments of Pediatrics and Obstetrics and Gynecology, Section of Neonatology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA

    J R Kaiser

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Correspondence to C J Rhee.

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Rhee, C., Fraser III, C., Kibler, K. et al. The ontogeny of cerebrovascular pressure autoregulation in premature infants. J Perinatol 34, 926–931 (2014). https://doi.org/10.1038/jp.2014.122

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