Cerebral and renal artery blood flow velocity before and after birth

doi:10.1016/0378-3782(96)01754-9

Early Human Development

Volume 46, Issues 1–2, 20 September 1996, Pages 165-174

https://doi.org/10.1016/0378-3782(96)01754-9 Get rights and content

Abstract

Objective: To document perinatal changes in cerebral and renal artery haemodynamics in premature growth-retarded and normal term infants. Design: Longitudinal study of individual infants. Doppler ultrasound measurements of blood flow velocity (BFV) in the middle cerebral and renal arteries were obtained before delivery, soon after delivery and during the first week of postnatal life. Setting: Teaching hospital obstetric and neonatal units. Subjects: 13 severely growth retarded infants born at 28–36 weeks gestation, and eight normally grown infants born at term. Results: In both groups, BFV in the cerebral artery was significantly lower in the first few hours after birth than in fetal life, but subsequently increased to reach pre-delivery values by the end of the first week. In contrast, BFV in the renal artery during the first postnatal day was not significantly different from fetal values, but it also increased during the subsequent week. In six of the preterm growth-retarded infants, fetal blood gases were measured in samples obtained by cordocentesis, and in these cases an increase in blood oxygen content at birth was documented. Conclusions: Cerebral artery BFV falls at birth and is relatively low during the time that premature infants are at the greatest risk of developing periventricular haemorrhage.

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Peri/intraventricular hemorrhage (P/IVH), a major complication of prematurity, increases the risk of mortality and is associated with significant short and long-term morbidities. Pathogenesis of P/IVH is complex and multifactorial. Given the immaturity of organ systems, the extremely preterm infant has inherent vulnerabilities, and lifesaving interventions aimed at supporting the developing organs such as mechanical ventilation may have unintended consequences and predispose the immature brain to injury. Among the potential contributors to development of P/IVH, cardiovascular compromise and altered cerebral hemodynamics during the transitional period are considered to play a major role. Recent advances in monitoring technology have enhanced our understanding of the transitional circulation and pathogenesis of P/IVH, and may prove to be useful in the selection of high-risk patients and testing strategies to prevent or decrease the incidence and severity of P/IVH.
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Therefore, in the lamb, CBF decreases at birth, primarily because of exposure to higher blood and thus tissue oxygen concentration. Doppler studies suggest that CBF deceases at birth in the human neonate also [4]. Interestingly, timing of cord clamping could have a significant effect on the postnatal changes in CBF (see Section 5.2).
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Relationship of Neonatal Cerebral Blood Flow Velocity Asymmetry with Early Motor, Cognitive and Language Development in Term Infants
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The birth and demographic characteristics for those infants who returned for developmental assessment (n = 52) are summarized in Table 1. Because previous studies have demonstrated acute changes in cerebral blood flow during the first 12 hours after birth (Hayashi et al. 1992; Kempley et al. 1996), we administered the cranial Doppler ultrasound examination to our infants between 12 hours and 5 days after birth. A warmer was positioned near the crib during the assessment to maintain the infant's temperature in the normal range.
The objective of this study was to examine the relationships of Doppler cerebral blood flow velocity (CBFV) asymmetry measures with developmental outcomes in term infants. Doppler CBFV parameters (peak systolic velocity [PSV] and mean velocity [MV]) of the bilateral middle cerebral arteries of 52 healthy term infants were prospectively examined on postnatal days 1–5, and then their motor, cognitive and language development was evaluated with the Bayley Scales of Infant and Toddler Development, Third Edition, at 6, 12, 18 and 24 months of age. The left CBFV asymmetry measure (PSV or MV) was calculated by subtracting the right-side value from the left-side value. Left CBFV asymmetry measures were significantly positively related to motor scores at 6 (r = 0.3–0.32, p < 0.05) and 12 (r = 0.35, p < 0.05) months of age, but were not related to cognitive or language outcome. Thus, the leftward hemodynamic status of the middle cerebral arteries, as measured by cranial Doppler ultrasound in the neonatal period, predicts early motor outcome in term infants.
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The aim of this study is to generate normal reference values of cerebral blood flow velocities (CBFV) and Doppler indices (DI) in the anterior (ACA) and the middle (MCA) cerebral arteries during the first month of life in “healthy” preterm infants. CBFV were obtained with color Doppler technique in seventy selected preterm infants divided in four groups of gestational age (GA) (25 to 28; 29 to 30; 31 to 32; 33 to 35 wk). Our data demonstrate that CBFV increase with rising GA, birth weight (BW) and postnatal age. Additionally, we can provide the median values, tenth and ninetieth percentiles of CBFV and DI, in the ACA and MCA in each GA group as reference normal values of CBFV and DI in preterm newborn. (E-mail: [email protected].)
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To investigate whether the mode of delivery may affect neonatal cerebral haemodynamics during the first hour of life.
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Near infra-red spectroscopy was used to measure changes of oxygenated haemoglobin, deoxygenated haemoglobin, oxidized-reduced cytochrome aa3, and mean cerebral oxygen saturation (mixed cerebral oxygen saturation = oxygenated haemoglobin/total haemoglobin). Changes in cerebral blood volume were calculated.
Near infra-red spectroscopy data did not show significant differences between infants born by vaginal delivery or by caesarean section. There was a significant decrease of oxygenated haemoglobin and change of cerebral blood volume values at 120 and 180 minutes in both the groups, while deoxygenated haemoglobin and oxidized-reduced cytochrome aa3 were unchanged.
A decrease of cerebral blood volume occurs after birth and this occurs both in infants born by vaginal delivery and by caesarean section.
Early and late environmental risk factors for schizophrenia
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Although a high proportion of liability to schizophrenia is under genetic control, a number of environmental risk factors have been identified. The earliest of these are complications of pregnancy and birth, though whether these cause or reflect disturbed brain development is not absolutely clear. Neurodevelopmental deviance is also indicated by neurological dysfunction, social, behavioural and cognitive deficits during childhood. Immigrant status is a significant risk factor, especially prominent among the African Caribbean population in England, though the mechanism is unknown. Later environmental risk factors include adverse life events and substance abuse. An additive model of multiple genetic and environmental risk factors of small effect may be too simplistic and an interactive model where genetic predisposition is compounded by environmental effects is more in keeping with current evidence. The nature of such interactions can be explored more fully when susceptibility genes for schizophrenia are identified.

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Cerebral and renal artery blood flow velocity before and after birth

Abstract

Lancet

Early Hum. Dev.

Ultrasound Med. Biol.

J. Pediatr.

J. Pediatr.

Middle cerebral artery flow velocity waveforms in fetal hypoxemia

Br. J. Obstet. Gynaecol.

Origin of periventricular haemorrhage in the preterm infant

Arch. Dis. Child.

Blood pressure fluctuation and intraventricular haemorrhage in the preterm infant of less than 31 weeks gestation

Pediatrics

Association of pneumothorax and hypotension with intraventricular haemorrhage

Arch. Dis. Child.