Observed and calculated cerebral critical closing pressure are highly correlated in preterm infants

Leah I. Elizondo, Danielle R. Rios, Eric Vu, Kathleen Kibler, R. Blaine Easley, Dean B. Andropoulos, Sebastian Acosta, Craig G. Rusin, Jeffrey R. Kaiser, Ken M. Brady, Christopher J. Rhee

Research output: Contribution to journalArticle

Abstract

Background: Cerebrovascular critical closing pressure (CrCP) is the arterial blood pressure (ABP) at which cerebral blood flow ceases. Preterm ABP is low and close to CrCP. The diastolic closing margin (diastolic ABP minus CrCP) has been associated with intraventricular hemorrhage in preterm infants. CrCP is estimated from middle cerebral artery cerebral blood flow velocity (CBFV) and ABP waveforms. However, these estimations have not been validated due to a lack of gold standard. Direct observation of the CrCP in preterm infants with hypotension is an opportunity to validate synchronously estimated CrCP. Methods: ABP and CBFV tracings were obtained from 24 extremely low birth weight infants. Recordings where diastolic CBFV was zero were identified. The gold standard CrCP was delineated using piecewise regression of ABP and CBFV values paired by rank ordering and then estimated using a published formula. The measured and estimated values were compared using linear regression and Bland–Altman analysis. Results: Linear regression showed a high degree of correlation between measured and calculated CrCP (r2 = 0.93). Conclusions: This is the first study to validate a calculated CrCP by comparing it to direct measurements of CrCP from preterm infants when ABP is lower than CrCP.

Original languageEnglish (US)
Pages (from-to)242-246
Number of pages5
JournalPediatric Research
Volume86
Issue number2
DOIs
StatePublished - Aug 1 2019

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Premature Infants
Cerebrovascular Circulation
Pressure
Arterial Pressure
Blood Flow Velocity
Linear Models
Extremely Low Birth Weight Infant
Middle Cerebral Artery
Hypotension
Regression Analysis
Observation
Hemorrhage

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

Cite this

Elizondo, L. I., Rios, D. R., Vu, E., Kibler, K., Easley, R. B., Andropoulos, D. B., ... Rhee, C. J. (2019). Observed and calculated cerebral critical closing pressure are highly correlated in preterm infants. Pediatric Research, 86(2), 242-246. https://doi.org/10.1038/s41390-019-0403-y
Elizondo, Leah I. ; Rios, Danielle R. ; Vu, Eric ; Kibler, Kathleen ; Easley, R. Blaine ; Andropoulos, Dean B. ; Acosta, Sebastian ; Rusin, Craig G. ; Kaiser, Jeffrey R. ; Brady, Ken M. ; Rhee, Christopher J. / Observed and calculated cerebral critical closing pressure are highly correlated in preterm infants. In: Pediatric Research. 2019 ; Vol. 86, No. 2. pp. 242-246.
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abstract = "Background: Cerebrovascular critical closing pressure (CrCP) is the arterial blood pressure (ABP) at which cerebral blood flow ceases. Preterm ABP is low and close to CrCP. The diastolic closing margin (diastolic ABP minus CrCP) has been associated with intraventricular hemorrhage in preterm infants. CrCP is estimated from middle cerebral artery cerebral blood flow velocity (CBFV) and ABP waveforms. However, these estimations have not been validated due to a lack of gold standard. Direct observation of the CrCP in preterm infants with hypotension is an opportunity to validate synchronously estimated CrCP. Methods: ABP and CBFV tracings were obtained from 24 extremely low birth weight infants. Recordings where diastolic CBFV was zero were identified. The gold standard CrCP was delineated using piecewise regression of ABP and CBFV values paired by rank ordering and then estimated using a published formula. The measured and estimated values were compared using linear regression and Bland–Altman analysis. Results: Linear regression showed a high degree of correlation between measured and calculated CrCP (r2 = 0.93). Conclusions: This is the first study to validate a calculated CrCP by comparing it to direct measurements of CrCP from preterm infants when ABP is lower than CrCP.",
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Elizondo, LI, Rios, DR, Vu, E, Kibler, K, Easley, RB, Andropoulos, DB, Acosta, S, Rusin, CG, Kaiser, JR, Brady, KM & Rhee, CJ 2019, 'Observed and calculated cerebral critical closing pressure are highly correlated in preterm infants', Pediatric Research, vol. 86, no. 2, pp. 242-246. https://doi.org/10.1038/s41390-019-0403-y

Observed and calculated cerebral critical closing pressure are highly correlated in preterm infants. / Elizondo, Leah I.; Rios, Danielle R.; Vu, Eric; Kibler, Kathleen; Easley, R. Blaine; Andropoulos, Dean B.; Acosta, Sebastian; Rusin, Craig G.; Kaiser, Jeffrey R.; Brady, Ken M.; Rhee, Christopher J.

In: Pediatric Research, Vol. 86, No. 2, 01.08.2019, p. 242-246.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Observed and calculated cerebral critical closing pressure are highly correlated in preterm infants

AU - Elizondo, Leah I.

AU - Rios, Danielle R.

AU - Vu, Eric

AU - Kibler, Kathleen

AU - Easley, R. Blaine

AU - Andropoulos, Dean B.

AU - Acosta, Sebastian

AU - Rusin, Craig G.

AU - Kaiser, Jeffrey R.

AU - Brady, Ken M.

AU - Rhee, Christopher J.

PY - 2019/8/1

Y1 - 2019/8/1

N2 - Background: Cerebrovascular critical closing pressure (CrCP) is the arterial blood pressure (ABP) at which cerebral blood flow ceases. Preterm ABP is low and close to CrCP. The diastolic closing margin (diastolic ABP minus CrCP) has been associated with intraventricular hemorrhage in preterm infants. CrCP is estimated from middle cerebral artery cerebral blood flow velocity (CBFV) and ABP waveforms. However, these estimations have not been validated due to a lack of gold standard. Direct observation of the CrCP in preterm infants with hypotension is an opportunity to validate synchronously estimated CrCP. Methods: ABP and CBFV tracings were obtained from 24 extremely low birth weight infants. Recordings where diastolic CBFV was zero were identified. The gold standard CrCP was delineated using piecewise regression of ABP and CBFV values paired by rank ordering and then estimated using a published formula. The measured and estimated values were compared using linear regression and Bland–Altman analysis. Results: Linear regression showed a high degree of correlation between measured and calculated CrCP (r2 = 0.93). Conclusions: This is the first study to validate a calculated CrCP by comparing it to direct measurements of CrCP from preterm infants when ABP is lower than CrCP.

AB - Background: Cerebrovascular critical closing pressure (CrCP) is the arterial blood pressure (ABP) at which cerebral blood flow ceases. Preterm ABP is low and close to CrCP. The diastolic closing margin (diastolic ABP minus CrCP) has been associated with intraventricular hemorrhage in preterm infants. CrCP is estimated from middle cerebral artery cerebral blood flow velocity (CBFV) and ABP waveforms. However, these estimations have not been validated due to a lack of gold standard. Direct observation of the CrCP in preterm infants with hypotension is an opportunity to validate synchronously estimated CrCP. Methods: ABP and CBFV tracings were obtained from 24 extremely low birth weight infants. Recordings where diastolic CBFV was zero were identified. The gold standard CrCP was delineated using piecewise regression of ABP and CBFV values paired by rank ordering and then estimated using a published formula. The measured and estimated values were compared using linear regression and Bland–Altman analysis. Results: Linear regression showed a high degree of correlation between measured and calculated CrCP (r2 = 0.93). Conclusions: This is the first study to validate a calculated CrCP by comparing it to direct measurements of CrCP from preterm infants when ABP is lower than CrCP.

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U2 - 10.1038/s41390-019-0403-y

DO - 10.1038/s41390-019-0403-y

M3 - Article

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AN - SCOPUS:85065179355

VL - 86

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JO - Pediatric Research

JF - Pediatric Research

SN - 0031-3998

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