The ontogeny of cerebrovascular pressure autoregulation in premature infants

C. J. Rhee, C. D. Fraser, K. Kibler, R. B. Easley, D. B. Andropoulos, M. Czosnyka, G. V. Varsos, P. Smielewski, C. G. Rusin, K. M. Brady, J. R. Kaiser

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Objective:To quantify cerebrovascular autoregulation as a function of gestational age (GA) and across the phases of the cardiac cycle.Study design:The present study is a hypothesis-generating re-analysis of previously published data. Premature infants (n=179) with a GA range of 23 to 33 weeks were monitored with umbilical artery catheters and transcranial Doppler insonation of the middle cerebral artery for 1-h sessions over the first week of life. Autoregulation was quantified by three methods, as a moving correlation coefficient between: (1) systolic arterial blood pressure (ABP) and systolic cerebral blood flow (CBF) velocity (Sx); (2) mean ABP and mean CBF velocity (Mx); and (3) diastolic ABP and diastolic CBF velocity (Dx). Comparisons of individual and cohort cerebrovascular pressure autoregulation were made across GA for each aspect of the cardiac cycle.Results:Systolic, mean and diastolic ABP increased with GA (r=0.3, 0.4 and 0.4; P<0.0001). Systolic CBF velocity was pressure-passive in infants with the lowest GA, and Sx decreased with advancing GA (r=-0.3; P<0.001), indicating increased capacity for cerebral autoregulation during systole during development. By contrast, Dx was elevated, indicating dysautoregulation, in all subjects and showed minimal change with advancing GA (r=-0.06; P=0.05). Multivariate analysis confirmed that both GA (P<0.001) and 'effective cerebral perfusion pressure' (ABP minus critical closing pressure (CrCP); P<0.01) were associated with Sx.Conclusion:Premature infants have low and usually pressure-passive diastolic CBF velocity. By contrast, the regulation of systolic CBF velocity by pressure autoregulation developed in this cohort between 23 and 33 weeks GA. Elevated effective cerebral perfusion pressure derived from the CrCP was associated with dysautoregulation.

Original languageEnglish (US)
Pages (from-to)926-931
Number of pages6
JournalJournal of Perinatology
Volume34
Issue number12
DOIs
StatePublished - Jan 1 2014

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Cerebrovascular Circulation
Premature Infants
Gestational Age
Homeostasis
Blood Flow Velocity
Pressure
Arterial Pressure
Umbilical Arteries
Systole
Middle Cerebral Artery
Multivariate Analysis
Catheters
Blood Pressure

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Rhee, C. J., Fraser, C. D., Kibler, K., Easley, R. B., Andropoulos, D. B., Czosnyka, M., ... Kaiser, J. R. (2014). The ontogeny of cerebrovascular pressure autoregulation in premature infants. Journal of Perinatology, 34(12), 926-931. https://doi.org/10.1038/jp.2014.122
Rhee, C. J. ; Fraser, C. D. ; Kibler, K. ; Easley, R. B. ; Andropoulos, D. B. ; Czosnyka, M. ; Varsos, G. V. ; Smielewski, P. ; Rusin, C. G. ; Brady, K. M. ; Kaiser, J. R. / The ontogeny of cerebrovascular pressure autoregulation in premature infants. In: Journal of Perinatology. 2014 ; Vol. 34, No. 12. pp. 926-931.
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abstract = "Objective:To quantify cerebrovascular autoregulation as a function of gestational age (GA) and across the phases of the cardiac cycle.Study design:The present study is a hypothesis-generating re-analysis of previously published data. Premature infants (n=179) with a GA range of 23 to 33 weeks were monitored with umbilical artery catheters and transcranial Doppler insonation of the middle cerebral artery for 1-h sessions over the first week of life. Autoregulation was quantified by three methods, as a moving correlation coefficient between: (1) systolic arterial blood pressure (ABP) and systolic cerebral blood flow (CBF) velocity (Sx); (2) mean ABP and mean CBF velocity (Mx); and (3) diastolic ABP and diastolic CBF velocity (Dx). Comparisons of individual and cohort cerebrovascular pressure autoregulation were made across GA for each aspect of the cardiac cycle.Results:Systolic, mean and diastolic ABP increased with GA (r=0.3, 0.4 and 0.4; P<0.0001). Systolic CBF velocity was pressure-passive in infants with the lowest GA, and Sx decreased with advancing GA (r=-0.3; P<0.001), indicating increased capacity for cerebral autoregulation during systole during development. By contrast, Dx was elevated, indicating dysautoregulation, in all subjects and showed minimal change with advancing GA (r=-0.06; P=0.05). Multivariate analysis confirmed that both GA (P<0.001) and 'effective cerebral perfusion pressure' (ABP minus critical closing pressure (CrCP); P<0.01) were associated with Sx.Conclusion:Premature infants have low and usually pressure-passive diastolic CBF velocity. By contrast, the regulation of systolic CBF velocity by pressure autoregulation developed in this cohort between 23 and 33 weeks GA. Elevated effective cerebral perfusion pressure derived from the CrCP was associated with dysautoregulation.",
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Rhee, CJ, Fraser, CD, Kibler, K, Easley, RB, Andropoulos, DB, Czosnyka, M, Varsos, GV, Smielewski, P, Rusin, CG, Brady, KM & Kaiser, JR 2014, 'The ontogeny of cerebrovascular pressure autoregulation in premature infants', Journal of Perinatology, vol. 34, no. 12, pp. 926-931. https://doi.org/10.1038/jp.2014.122

The ontogeny of cerebrovascular pressure autoregulation in premature infants. / Rhee, C. J.; Fraser, C. D.; Kibler, K.; Easley, R. B.; Andropoulos, D. B.; Czosnyka, M.; Varsos, G. V.; Smielewski, P.; Rusin, C. G.; Brady, K. M.; Kaiser, J. R.

In: Journal of Perinatology, Vol. 34, No. 12, 01.01.2014, p. 926-931.

Research output: Contribution to journalArticle

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T1 - The ontogeny of cerebrovascular pressure autoregulation in premature infants

AU - Rhee, C. J.

AU - Fraser, C. D.

AU - Kibler, K.

AU - Easley, R. B.

AU - Andropoulos, D. B.

AU - Czosnyka, M.

AU - Varsos, G. V.

AU - Smielewski, P.

AU - Rusin, C. G.

AU - Brady, K. M.

AU - Kaiser, J. R.

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Y1 - 2014/1/1

N2 - Objective:To quantify cerebrovascular autoregulation as a function of gestational age (GA) and across the phases of the cardiac cycle.Study design:The present study is a hypothesis-generating re-analysis of previously published data. Premature infants (n=179) with a GA range of 23 to 33 weeks were monitored with umbilical artery catheters and transcranial Doppler insonation of the middle cerebral artery for 1-h sessions over the first week of life. Autoregulation was quantified by three methods, as a moving correlation coefficient between: (1) systolic arterial blood pressure (ABP) and systolic cerebral blood flow (CBF) velocity (Sx); (2) mean ABP and mean CBF velocity (Mx); and (3) diastolic ABP and diastolic CBF velocity (Dx). Comparisons of individual and cohort cerebrovascular pressure autoregulation were made across GA for each aspect of the cardiac cycle.Results:Systolic, mean and diastolic ABP increased with GA (r=0.3, 0.4 and 0.4; P<0.0001). Systolic CBF velocity was pressure-passive in infants with the lowest GA, and Sx decreased with advancing GA (r=-0.3; P<0.001), indicating increased capacity for cerebral autoregulation during systole during development. By contrast, Dx was elevated, indicating dysautoregulation, in all subjects and showed minimal change with advancing GA (r=-0.06; P=0.05). Multivariate analysis confirmed that both GA (P<0.001) and 'effective cerebral perfusion pressure' (ABP minus critical closing pressure (CrCP); P<0.01) were associated with Sx.Conclusion:Premature infants have low and usually pressure-passive diastolic CBF velocity. By contrast, the regulation of systolic CBF velocity by pressure autoregulation developed in this cohort between 23 and 33 weeks GA. Elevated effective cerebral perfusion pressure derived from the CrCP was associated with dysautoregulation.

AB - Objective:To quantify cerebrovascular autoregulation as a function of gestational age (GA) and across the phases of the cardiac cycle.Study design:The present study is a hypothesis-generating re-analysis of previously published data. Premature infants (n=179) with a GA range of 23 to 33 weeks were monitored with umbilical artery catheters and transcranial Doppler insonation of the middle cerebral artery for 1-h sessions over the first week of life. Autoregulation was quantified by three methods, as a moving correlation coefficient between: (1) systolic arterial blood pressure (ABP) and systolic cerebral blood flow (CBF) velocity (Sx); (2) mean ABP and mean CBF velocity (Mx); and (3) diastolic ABP and diastolic CBF velocity (Dx). Comparisons of individual and cohort cerebrovascular pressure autoregulation were made across GA for each aspect of the cardiac cycle.Results:Systolic, mean and diastolic ABP increased with GA (r=0.3, 0.4 and 0.4; P<0.0001). Systolic CBF velocity was pressure-passive in infants with the lowest GA, and Sx decreased with advancing GA (r=-0.3; P<0.001), indicating increased capacity for cerebral autoregulation during systole during development. By contrast, Dx was elevated, indicating dysautoregulation, in all subjects and showed minimal change with advancing GA (r=-0.06; P=0.05). Multivariate analysis confirmed that both GA (P<0.001) and 'effective cerebral perfusion pressure' (ABP minus critical closing pressure (CrCP); P<0.01) were associated with Sx.Conclusion:Premature infants have low and usually pressure-passive diastolic CBF velocity. By contrast, the regulation of systolic CBF velocity by pressure autoregulation developed in this cohort between 23 and 33 weeks GA. Elevated effective cerebral perfusion pressure derived from the CrCP was associated with dysautoregulation.

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Rhee CJ, Fraser CD, Kibler K, Easley RB, Andropoulos DB, Czosnyka M et al. The ontogeny of cerebrovascular pressure autoregulation in premature infants. Journal of Perinatology. 2014 Jan 1;34(12):926-931. https://doi.org/10.1038/jp.2014.122