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J Pediatr. 2015 Jul;167(1):86-91. doi: 10.1016/j.jpeds.2015.03.041. Epub 2015 Apr 17.

Monitoring of Cerebrovascular Reactivity for Determination of Optimal Blood Pressure in Preterm Infants.

Author information

1
Neonatal Unit, Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom. Electronic address: cs702@cam.ac.uk.
2
Department of Clinical Neurosciences, Academic Neurosurgical Unit, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom; Institute of Electronic Systems, Warsaw University of Technology, Warsaw, Poland.
3
Department of Clinical Neurosciences, Academic Neurosurgical Unit, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
4
Neonatal Unit, Elizabeth Garret Anderson Wing, University College London Hospital, London, United Kingdom.
5
Neonatal Unit, Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.

Abstract

OBJECTIVE:

To define levels of mean arterial blood pressure (MABP) where cerebrovascular reactivity is strongest in preterm infants (ie, optimal MABP, or MABPOPT) and correlate deviations from MABPOPT with mortality and intraventricular hemorrhage (IVH).

STUDY DESIGN:

A total of 60 preterm infants born at median gestational age 26 ± 2 weeks (23 ± 2 to 32 ± 1) with indwelling arterial catheter were studied at a median 34 hours (range 5-228) of age. Tissue oxygenation heart rate (HR) reactivity index, which estimates cerebrovascular reactivity, was calculated as the moving correlation coefficient between slow waves of tissue oxygenation index, measured with near-infrared spectroscopy, and HR. MABPOPT was defined by dividing MABP into 2-mm Hg bins and averaging the tissue oxygenation HR reactivity index within those bins. A measurement of divergence from MABPOPT was calculated as the absolute difference between mean MABP and mean MABPOPT.

RESULTS:

Individual MABPOPT was defined in 81% of the patients. A measurement of divergence from MABPOPT was greater in those patients who died (mean 4.2 mm Hg; 95% CI 3.33-4.96) compared with those who survived (mean 2.1 mm Hg; 95% CI 1.64-2.56), P = .013. Patients who had MABP lower than MABPOPT by 4 mm Hg or more had a greater rate of mortality (40%) than those with MABP close to or above MABPOPT (13%), P = .049. Patients with MABP greater than MABPOPT by 4 mm Hg had greater IVH scores, P = .042.

CONCLUSIONS:

Continuous monitoring of cerebrovascular reactivity allows the determination of MABPOPT in preterm neonates. Significant deviation below MABPOPT was observed in infants who died. Deviation of MABP above optimal level was observed in infants who developed more severe IVH.

PMID:
25891381
DOI:
10.1016/j.jpeds.2015.03.041
[Indexed for MEDLINE]

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