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Original article
Cerebral autoregulation in premature infants during the first 96 hours of life and relationship to adverse outcomes
  1. Suma B Hoffman1,
  2. Yun-Ju Cheng2,
  3. Laurence S Magder3,
  4. Narendra Shet4,
  5. Rose M Viscardi1
  1. 1 Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
  2. 2 Department of Mathematics and Statistics, University of Maryland Baltimore County, Baltimore, Maryland, USA
  3. 3 Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
  4. 4 Department of Diagnostic Imaging and Radiology, Children’s National Health System, Michigan Avenue NW, Washington, DC, USA
  1. Correspondence to Dr Suma B Hoffman, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA; shoffman{at}som.umaryland.edu

Abstract

Objective To test the hypothesis that impaired cerebral autoregulation (ICA) increases the susceptibility of premature infants to adverse outcomes, we determined the relationship of ICA and cerebral reactivity (CR) measured in the first 96 hours of life to the outcome of grade 3 or 4 intraventricular haemorrhage (IVH) and/or death within 1 month.

Setting Single-centre level IV neonatal intensive care unit.

Patients Neonates 24–29 weeks’ gestation less than 12 hours old with invasive blood pressure monitoring.

Design Cerebral saturations and mean arterial blood pressure were recorded every 30 s for 96 hours. For each 10 min epoch, the correlation coefficient (r) was calculated for mean arterial blood pressure versus cerebral saturations. The epoch was considered to have ICA if r>0.5 and CR if r<0.

Results Sixty-one subjects were included. During the first 96 hours, ICA occurred 17.6% and CR occurred 41% of recorded time. In those without adverse outcomes, ICA decreased and CR increased by postnatal day (p<0.05). Adjusted for birth weight and gestational age, those with IVH and those who died spent more time with ICA and less time with CR (p<0.05) over the entire recording period. Those with IVH had 1.5-fold increase in time with ICA on day 2 (p=0.021), and decrease in time with CR on day 3 (p=0.036). Compared with survivors, non-survivors spent more time with ICA on days 3 and 4 (p<0.005), and less with CR on day 3 (p=0.032).

Conclusion ICA and CR vary by postnatal day and these patterns are associated with adverse outcomes.

  • cerebral autoregulation
  • prematurity
  • IVH
  • cerebral reactivity
  • NIRS

https://doi.org/10.1136/archdischild-2018-315725

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    Footnotes

    • Contributors SBH was responsible for the original draft, the concept and design, collection, analysis and interpretation of data, and drafting and revising the manuscript. YJC was responsible for the design, data analysis and interpretation, and manuscript revision. LSM was responsible for the concept, design, data analysis and interpretation, and manuscript revision. NS was responsible for the design, data acquisition and manuscript revision. RMV was responsible for the concept, design, data interpretation and manuscript revision. All authors have approved the manuscript as submitted.

    • Funding This work was funded by the Mentored Population and Clinical Research Program of the American Heart Association (Award No 14CRP18140003 to SBH, LSM, and RMV).

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval University of Maryland Medical Center Institutional Review Board.

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

    • Data sharing statement There are no unpublished data available for sharing.