Original article| Volume 24, ISSUE 7, P693-697, October 2002

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Cerebral hemodynamics during early neonatal period in preterm infants with periventricular leukomalacia


      We prospectively investigated the relation among cerebral blood flow, periventricular leukomalacia (PVL) and hypocarbia using Doppler ultrasonography in 53 preterm infants with gestational age between 27 and 34 weeks who required mechanical ventilation during the first 72 h of life. Cerebral blood flow of pericallosal artery was assessed by Doppler ultrasonography at the first and the third day of life. Mean velocity (MV) and Resistance index (RI) of anterior cerebral artery were calculated from the data obtained by Doppler ultrasonography. The diagnosis of PVL was made in 12 infants on the basis of the results of ultrasonography and MRI. Hypocarbia was judged as positive when both arterial blood gas analyses before and after the ultrasonography revealed PaCO2 values <25 mmHg. On the first day of life, RI was 0.62±0.022 in infants with PVL and 0.71±0.014 in those without PVL. On the third day of life, RI was 0.60±0.032 in infants with PVL and 0.66±0.013 in those without PVL. There was a significant difference in RI between the two groups at either point. MV was not significantly different between the two groups at either point. There was no significant difference in RI or MV between infants with and without hypocarbia at either point. RI was significantly lower in infants with PVL during the first 72 h of life, which is suggestive of vasoparalysis in such infants at the level of major cerebral arteries. However, RI or MV was no different between infants with and without hypocarbia.


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        • Archer L.N.
        • Levene M.I.
        • Evans D.H.
        Cerebral artery Doppler ultrasonography for prediction of outcome after perinatal asphyxia.
        Lancet. 1986; 2: 1116-1118
        • Ramaekers V.T.
        • Casaer P.
        Defective regulation of cerebral oxygen transport after severe birth asphyxia.
        Dev Med Child Neurol. 1990; 32: 56-62
        • Levene M.I.
        • Fenton A.C.
        • Evans D.H.
        • Archer L.N.
        • Shortland D.B.
        • Gibson N.A.
        Severe birth asphyxia and abnormal cerebral blood-flow velocity.
        Dev Med Child Neurol. 1989; 31: 427-434
        • Wyatt J.S.
        Near infrared spectroscopy in asphyxiated brain injury.
        Clin Perinatol. 1993; 20: 369-378
        • Pryds O.
        • Greisen G.
        • Lou H.
        • Friis-Hansen B.
        Vasoparalysis associated with brain damage in asphyxiated term infants.
        J Pediatr. 1990; 117: 119-125
        • Rosenbaum J.L.
        • Almli C.R.
        • Yundt K.D.
        • Altman D.I.
        • Powers W.J.
        Higher neonatal blood flow correlates with worse childhood neurologic outcome.
        Neurology. 1997; 49: 1035-1041
        • Baenziger O.
        • Mueller A.M.
        • Morales C.G.
        • Jaggi J.L.
        • Duc G.
        • von Siebenthal K.
        • et al.
        Cerebral blood flow and neurological outcome in the preterm infant.
        Eur J Pediatr. 1999; 158: 138-143
        • Meek J.H.
        • Tyszczuk L.
        • Elwell C.E.
        • Wyatt J.S.
        Low cerebral blood flow is a risk factor for severe intraventricular hemorrhage.
        Arch Dis Child Fetal Neonatal Ed. 1999; 81: F15-F18
        • Tsuji M.
        • Saul P.
        • du Plessis A.
        • Eichenwald E.
        • Sobh J.
        • Crocker R.
        • et al.
        Cerebral intravascular oxygenation correlates with mean arterial pressure in critically ill preterm infants.
        Pediatrics. 2000; 106: 625-632
        • Wiswell T.E.
        • Graziani L.J.
        • Kornhauser M.S.
        • Stanley C.
        • Merton D.A.
        • McKee L.
        • et al.
        Effects of hypocarbia on the development of cystic periventricular leukomalacia in premature infants treated with high-frequency jet ventilation.
        Pediatrics. 1996; 98: 918-924
        • Graziani L.J.
        • Spitzer A.R.
        • Mitchell D.G.
        • Merton D.A.
        • Stanley C.
        • Robinson N.
        • et al.
        Mechanical ventilation in preterm infants: neurosonographic and developmental studies.
        Pediatrics. 1992; 90: 515-522
        • Fujimoto S.
        • Togari H.
        • Yamaguchi N.
        • Mizutani F.
        • Suzuki S.
        • Sobajima H.
        Hypocarbia and cystic periventricular leukomalacia in preterm infants.
        Arch Dis Child. 1994; 71: F107-F110
        • Greisen G.
        • Munck H.
        • Lou H.
        Severe hypocarbia in preterm infants and neurodevelopmental deficit.
        Acta Pediatr Scand. 1987; 76: 401-404
        • Calvert S.A.
        • Hoskins E.M.
        • Fong K.W.
        • Forsyth S.C.
        Etiological factors associated with the development of periventricular leukomalacia.
        Acta Pediatr Scand. 1987; 76: 254-259
        • Trounce J.Q.
        • Shaw D.E.
        • Levene M.I.
        • Rutter N.
        Clinical risk factors and periventricular leukomalacia.
        Arch Dis Child. 1988; 63: 17-22
        • Okumura A.
        • Hayakawa F.
        • Kato T.
        • Itomi K.
        • Maruyama K.
        • Ishihara N.
        • et al.
        Hypocarbia in preterm infants with periventricular leukomalacia: the relation between hypocarbia and mechanical ventilation.
        Pediatrics. 2001; 107: 469-475
        • Hayakawa F.
        • Okumura A.
        • Kato T.
        • Kuno K.
        • Watanabe K.
        Determination of timing of brain injury in preterm infants with periventricular leukomalacia with serial neonatal electroencephalography.
        Pediatrics. 1999; 104: 1077-1081
        • Watanabe K.
        • Hayakawa F.
        • Okumura A.
        Neonatal EEG: a powerful tool in the assessment of brain damage in preterm infants.
        Brain Dev. 1999; 21: 361-372
        • Boylan G.B.
        • Young K.
        • Panerai R.B.
        • Rennie J.M.
        • Evans D.H.
        Dynamic cerebral autoregulation in sick newborn infants.
        Pediatr Res. 2000; 48: 12-17
        • Okumura A.
        • Hayakawa F.
        • Kato T.
        • Kubota T.
        • Maruyama K.
        • Itomi K.
        • et al.
        Physical condition of preterm infants with periventricular leukomalacia.
        Brain Dev. 2001; 23: 805-809
        • Tyszczuk L.
        • Meek J.
        • Elwell C.
        • Wyatt J.S.
        Cerebral blood flow is independent of mean arterial blood pressure in preterm infants undergoing intensive care.
        Pediatrics. 1998; 102: 337-341