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Original article
Cerebrovascular autoregulation in preterm fetal growth restricted neonates
  1. Emily Cohen1,2,
  2. Willem Baerts1,
  3. Alexander Caicedo Dorado3,
  4. Gunnar Naulaers4,
  5. Frank van Bel1,
  6. Petra M A Lemmers1
  1. 1 Department of Neonatology, Wilhelmina Children’s Hospital/University Medical Centre Utrecht, Utrecht, The Netherlands
  2. 2 The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
  3. 3 Department of Applied Mathematics and Computer Science, Faculty of Natural Sciences and Mathematics, Universidad del Rosario, Bogota, Colombia
  4. 4 Department of Neonatology, University Hospital Leuven, Leuven, Belgium
  1. Correspondence to Dr Petra M A Lemmers, Department of Neonatology, Wilhelmina Children’s Hospital/University Medical Centre Utrecht, Utrecht 3584AE, The Netherlands; p.lemmers{at}umcutrecht.nl

Abstract

Objective To investigate the effect of fetal growth restriction (FGR) on cerebrovascular autoregulation in preterm neonates during the first 3 days of life.

Design Case–control study.

Setting Neonatal intensive care unit of the Wilhelmina Children’s Hospital, The Netherlands.

Patients 57 FGR (birth weight <10th percentile) and 57 appropriate for gestational age (AGA) (birth weight 20th–80th percentiles) preterm neonates, matched for gender, gestational age, respiratory and blood pressure support.

Methods The correlation between continuously measured mean arterial blood pressure and regional cerebral oxygen saturation was calculated to generate the cerebral oximetry index (COx). Mean COx was calculated for each patient for each postnatal day. The percentage of time with impaired autoregulation (COx>0.5) was also calculated.

Results FGR neonates had higher mean COx values than their AGA peers on day 2 (0.15 (95% CI 0.11 to 0.18) vs 0.09 (95% CI 0.06 to 0.13), p=0.029) and day 3 (0.17 (95% CI 0.13 to 0.20) vs 0.09 (95% CI 0.06 to 0.12), p=0.003) of life. FGR neonates spent more time with impaired autoregulation (COx value >0.5) than controls on postnatal day 2 (19% (95% CI 16% to 22%) vs 14% (95% CI 12% to 17%), p=0.035) and day 3 (20% (95% CI 17% to 24%) vs 15% (95% CI 12% to 18%), p=0.016).

Conclusion FGR preterm neonates more frequently display impaired cerebrovascular autoregulation compared with AGA peers on days 2 and 3 of life which may predispose them to brain injury. Further studies are required to investigate whether this impairment persists beyond the first few days of life and whether this impairment is linked to poor neurodevelopmental outcome.

  • fetal growth restriction (FGR)
  • cerebrovascular autoregulation
  • prematurity
  • intrauterine growth restriction (IUGR)
  • near-infrared spectroscopy (NIRS)

https://doi.org/10.1136/archdischild-2017-313712

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    Footnotes

    • Contributors EC carried out all data analyses, interpreted and critically appraised the data and drafted the initial manuscript. FvB, WB and PMAL were responsible for data collection, contributed substantially to interpretation and critical appraisal of the data and critically reviewed the manuscript. ACD and GN contributed substantially to interpretation and critical appraisal of the data and critically reviewed the manuscript. All authors have seen and approved the final version of the manuscript as submitted.

    • Funding A scholarship was provided to EC by Red Nose Australia. ACD is a postdoctoral fellow of the Research Foundation Flanders (FWO).

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval Medical Ethical Committee of the University Medical Centre Utrecht.

    • Provenance and peer review Not commissioned; externally peer reviewed.