The diastolic closing margin is associated with intraventricular hemorrhage in premature infants

Christopher J. Rhee, Kathleen K. Kibler, R. Blaine Easley, Dean B. Andropoulos, Marek Czosnyka, Peter Smielewski, Georgios V. Varsos, Ken M. Brady, Craig G. Rusin, Charles D. Fraser, C. Heath Gauss, D. Keith Williams, Jeffrey R. Kaiser

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Premature infants are at an increased risk of intraventricular hemorrhage (IVH). The roles of hypotension and hyperemia are still debated. Critical closing pressure (CrCP) is the arterial blood pressure (ABP) at which cerebral blood flow (CBF) ceases. When diastolic ABP is equal to CrCP, CBF occurs only during systole. The difference between diastolic ABP and CrCP is the diastolic closing margin (DCM). We hypothesized that a low DCM was associated with IVH. One hundred eighty-six premature infants, with a gestational age (GA) range of 23-33 weeks, were monitored with umbilical artery catheters and transcranial Doppler insonation of middle cerebral artery flow velocity for 1-h sessions over the first week of life. CrCP was calculated linearly and using an impedance model. A multivariate generalized linear regression model was used to determine associations with severe IVH (grades 3-4). An elevated DCM by either method was associated with IVH (p < 0.0001 for the linear method; p < 0.001 for the impedance model). Lower 5-min Apgar scores, elevated mean CBF velocity, and lower mean ABP were also associated with IVH (p < 0.0001). Elevated DCM, not low DCM, was associated with severe IVH in this cohort.

Original languageEnglish (US)
Pages (from-to)147-150
Number of pages4
JournalActa Neurochirurgica, Supplementum
Volume122
DOIs
StatePublished - Jan 1 2016

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Premature Infants
Cerebrovascular Circulation
Hemorrhage
Arterial Pressure
Electric Impedance
Pressure
Linear Models
Umbilical Arteries
Apgar Score
Blood Flow Velocity
Systole
Hyperemia
Middle Cerebral Artery
Hypotension
Gestational Age
Catheters
Blood Pressure

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Rhee, Christopher J. ; Kibler, Kathleen K. ; Easley, R. Blaine ; Andropoulos, Dean B. ; Czosnyka, Marek ; Smielewski, Peter ; Varsos, Georgios V. ; Brady, Ken M. ; Rusin, Craig G. ; Fraser, Charles D. ; Gauss, C. Heath ; Williams, D. Keith ; Kaiser, Jeffrey R. / The diastolic closing margin is associated with intraventricular hemorrhage in premature infants. In: Acta Neurochirurgica, Supplementum. 2016 ; Vol. 122. pp. 147-150.
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abstract = "Premature infants are at an increased risk of intraventricular hemorrhage (IVH). The roles of hypotension and hyperemia are still debated. Critical closing pressure (CrCP) is the arterial blood pressure (ABP) at which cerebral blood flow (CBF) ceases. When diastolic ABP is equal to CrCP, CBF occurs only during systole. The difference between diastolic ABP and CrCP is the diastolic closing margin (DCM). We hypothesized that a low DCM was associated with IVH. One hundred eighty-six premature infants, with a gestational age (GA) range of 23-33 weeks, were monitored with umbilical artery catheters and transcranial Doppler insonation of middle cerebral artery flow velocity for 1-h sessions over the first week of life. CrCP was calculated linearly and using an impedance model. A multivariate generalized linear regression model was used to determine associations with severe IVH (grades 3-4). An elevated DCM by either method was associated with IVH (p < 0.0001 for the linear method; p < 0.001 for the impedance model). Lower 5-min Apgar scores, elevated mean CBF velocity, and lower mean ABP were also associated with IVH (p < 0.0001). Elevated DCM, not low DCM, was associated with severe IVH in this cohort.",
author = "Rhee, {Christopher J.} and Kibler, {Kathleen K.} and Easley, {R. Blaine} and Andropoulos, {Dean B.} and Marek Czosnyka and Peter Smielewski and Varsos, {Georgios V.} and Brady, {Ken M.} and Rusin, {Craig G.} and Fraser, {Charles D.} and Gauss, {C. Heath} and Williams, {D. Keith} and Kaiser, {Jeffrey R.}",
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Rhee, CJ, Kibler, KK, Easley, RB, Andropoulos, DB, Czosnyka, M, Smielewski, P, Varsos, GV, Brady, KM, Rusin, CG, Fraser, CD, Gauss, CH, Williams, DK & Kaiser, JR 2016, 'The diastolic closing margin is associated with intraventricular hemorrhage in premature infants', Acta Neurochirurgica, Supplementum, vol. 122, pp. 147-150. https://doi.org/10.1007/978-3-319-22533-3_30

The diastolic closing margin is associated with intraventricular hemorrhage in premature infants. / Rhee, Christopher J.; Kibler, Kathleen K.; Easley, R. Blaine; Andropoulos, Dean B.; Czosnyka, Marek; Smielewski, Peter; Varsos, Georgios V.; Brady, Ken M.; Rusin, Craig G.; Fraser, Charles D.; Gauss, C. Heath; Williams, D. Keith; Kaiser, Jeffrey R.

In: Acta Neurochirurgica, Supplementum, Vol. 122, 01.01.2016, p. 147-150.

Research output: Contribution to journalArticle

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T1 - The diastolic closing margin is associated with intraventricular hemorrhage in premature infants

AU - Rhee, Christopher J.

AU - Kibler, Kathleen K.

AU - Easley, R. Blaine

AU - Andropoulos, Dean B.

AU - Czosnyka, Marek

AU - Smielewski, Peter

AU - Varsos, Georgios V.

AU - Brady, Ken M.

AU - Rusin, Craig G.

AU - Fraser, Charles D.

AU - Gauss, C. Heath

AU - Williams, D. Keith

AU - Kaiser, Jeffrey R.

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Premature infants are at an increased risk of intraventricular hemorrhage (IVH). The roles of hypotension and hyperemia are still debated. Critical closing pressure (CrCP) is the arterial blood pressure (ABP) at which cerebral blood flow (CBF) ceases. When diastolic ABP is equal to CrCP, CBF occurs only during systole. The difference between diastolic ABP and CrCP is the diastolic closing margin (DCM). We hypothesized that a low DCM was associated with IVH. One hundred eighty-six premature infants, with a gestational age (GA) range of 23-33 weeks, were monitored with umbilical artery catheters and transcranial Doppler insonation of middle cerebral artery flow velocity for 1-h sessions over the first week of life. CrCP was calculated linearly and using an impedance model. A multivariate generalized linear regression model was used to determine associations with severe IVH (grades 3-4). An elevated DCM by either method was associated with IVH (p < 0.0001 for the linear method; p < 0.001 for the impedance model). Lower 5-min Apgar scores, elevated mean CBF velocity, and lower mean ABP were also associated with IVH (p < 0.0001). Elevated DCM, not low DCM, was associated with severe IVH in this cohort.

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