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Hemodynamics of infants with strong fluctuations of internal cerebral vein
Author(s) -
Ikeda Toshifumi,
Ito Yuya,
Mikami Ryosuke,
Matsuo Koji,
Kawamura Naoto,
Yamoto Akane
Publication year - 2019
Publication title -
pediatrics international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 63
eISSN - 1442-200X
pISSN - 1328-8067
DOI - 10.1111/ped.13828
Subject(s) - medicine , cardiology , cerebral perfusion pressure , hemodynamics , cerebral blood flow , blood pressure , perfusion , diastole , gestational age , anesthesia , pregnancy , biology , genetics
Background There is a high incidence of intraventricular hemorrhage in extremely low‐birthweight ( ELBW ) infants of low gestational age with high‐grade fluctuations in the perfusion waveform of the internal cerebral vein. This study investigated changes in the hemodynamic status of ELBW infants during initial strong fluctuations in the perfusion waveform of the internal cerebral vein. Methods We evaluated the perfusion waveform of the internal cerebral vein in 192 ELBW infants from birth, every 8 h for a total of 120 h. Sixty‐seven infants had high‐grade fluctuations. On the basis of the presence of patent ductus arteriosus ( PDA ), patients were subdivided into PDA (−) ( n = 32) and PDA (+) ( n = 35) groups. Results During the first high‐grade fluctuation, the PDA (−) group had significant increases in systolic, diastolic, and mean blood pressure ( P < 0.001 for all). The PDA (+) group did not have significant changes in blood pressure but did have significant increases in the number of interruptions or regurgitations of diastolic renal arterial blood flow ( P = 0.04) and end‐diastolic left pulmonary arterial flow velocity ( P < 0.001), indicating increased left‐to‐right shunt. Conclusions Blood pressure elevation may underlie fluctuations in the perfusion waveform of the internal cerebral vein and lead to the first high‐grade increases during acute management of ELBW infants. When no elevation in blood pressure occurred, hemodynamically significant PDA was considered a potential underlying factor.