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Low cerebral blood flow resistance in nonventilated preterm infants predicts poor neurologic outcome

Ojala, Tiina MD, PhD; Kääpä, Pekka MD, PhD; Helenius, Hans MSc; Ekblad, Ulla MD, PhD; Kero, Pentti MD, PhD; Välimäki, Ilkka MD, MSc; Äärimaa, Tuula MD, PhD

Pediatric Critical Care Medicine: May 2004 - Volume 5 - Issue 3 - p 264-268
doi: 10.1097/01.PCC.0000112368.32965.45
Clinical Investigations

Objectives: To examine whether cerebral blood flow variables during the first critical day of life can predict the 1-yr neurologic outcome in ventilated and nonventilated preterm infants.

Design: Prospective follow-up study.

Setting: Neonatal intensive care unit of university central hospital.

Patients: Forty-nine preterm infants <33 wks of gestation.

Interventions: Doppler ultrasound investigations of the brain circulation, heart rate, and systemic blood pressure were performed in ventilated (n = 35) and nonventilated (n = 14) preterm infants during the first day of life. The neurologic development was evaluated using Griffith’s subscales at 12 months of corrected age.

Measurements and Main Results: Cerebral blood flow velocity measurements were obtained from the anterior cerebral artery and internal carotid artery. Cerebral blood flow, cerebral blood flow resistance, and cerebral perfusion pressure subsequently were derived. These derived cerebral perfusion variables were associated with the sum of Griffith’s developmental scales (p < .02). However, the slopes of regression lines between cerebral blood flow or cerebral blood flow resistance and the sum of Griffith’s psychomotor developmental scales tended to be different in the ventilated and nonventilated infants (p = .06, p = .003, respectively). The correlations between these variables and the sum of Griffith’s psychomotor developmental scales were significant only in nonventilated preterm infants (r = .69, p = .007, and r = −.85, p = .001, respectively).

Conclusions: Our data suggest that lowered cerebral blood flow resistance reflecting lowered cerebral blood flow during early circulatory transition is associated with adverse outcome in nonventilated preterm infants, but no connection in ventilated infants was found.

From the Research Centre of Applied and Preventive Cardiovascular Medicine, The Departments of Pediatrics and Obstetrics, and The Unit of Pediatric Neurology, University of Turku, Finland.

Supported, in part, by grants from the Research Foundation of Orion Corporation, the Turku University Foundation, and the Sigrid Juselius Foundation, Finland.

©2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies