Elevated cerebral pressure passivity is associated with prematurity-related intracranial hemorrhage.
Elevated cerebral pressure passivity is associated with prematurity-related intracranial hemorrhage.
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DOI：
10.1542/peds.2008-2004
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发表时间：
2009-07
期刊：
影响因子：
8
通讯作者：
du Plessis AJ
中科院分区：
文献类型：
--
作者：
O'Leary H;Gregas MC;Limperopoulos C;Zaretskaya I;Bassan H;Soul JS;Di Salvo DN;du Plessis AJ
脑压被动性在患病的早产儿中很常见，可能易引发生发基质/脑室内出血（GM/IVH），这是一种可能具有严重后果的病变。我们研究了脑压被动性的程度与GM/IVH之间的关联。
我们纳入了孕周<32周且有留置平均动脉压（MAP）监测的婴儿，并排除了已知患有先天性综合征或产前脑损伤的婴儿。我们以2Hz的频率记录连续的MAP和脑近红外光谱血红蛋白差值（HbD）信号，每天长达12小时，最多持续5天。在3个频段（0.05 - 0.25、0.25 - 0.5和0.5 - 1.0Hz）对MAP和HbD信号进行相干性和传递函数分析。利用MAP - HbD增益以及临床变量（包括绒毛膜羊膜炎、阿普加评分、孕周、出生体重、新生儿败血症和新生儿急性生理学评分II），我们建立了一个能最佳预测颅脑超声异常的逻辑回归模型。
在88名婴儿（中位孕周：26周[范围23 - 30周]）中，早期颅脑超声显示31名（37%）婴儿有GM/IVH，10名（12%）婴儿有脑实质回声增强；晚期颅脑超声显示19名（30%）婴儿有脑实质异常。低频MAP - HbD增益（最高四分位数均值）与早期GM/IVH显著相关，但与其他超声检查结果无关。与早期GM/IVH相关的最简模型仅包括孕周和MAP - HbD增益。
这种新的脑血管监测技术能够将早产儿的脑压被动性量化为MAP - HbD增益。我们表明高MAP - HbD增益与GM/IVH显著相关。MAP - HbD增益与GM/IVH之间的确切时间和因果关系有待进一步研究。
Cerebral pressure passivity is common in sick premature infants and may predispose to germinal matrix/intraventricular hemorrhage (GM/IVH), a lesion with potentially serious consequences. We studied the association between the magnitude of cerebral pressure passivity and GM/IVH. We enrolled infants <32 weeks’ gestational age with indwelling mean arterial pressure (MAP) monitoring and excluded infants with known congenital syndromes or antenatal brain injury. We recorded continuous MAP and cerebral near-infrared spectroscopy hemoglobin difference (HbD) signals at 2 Hz for up to 12 hours/day and up to 5 days. Coherence and transfer function analysis between MAP and HbD signals was performed in 3 frequency bands (0.05–0.25, 0.25–0.5, and 0.5–1.0 Hz). Using MAP-HbD gain and clinical variables (including chorioamnionitis, Apgar scores, gestational age, birth weight, neonatal sepsis, and Score for Neonatal Acute Physiology II), we built a logistic regression model that best predicts cranial ultrasound abnormalities. In 88 infants (median gestational age: 26 weeks [range 23–30 weeks]), early cranial ultrasound showed GM/IVH in 31 (37%) and parenchymal echodensities in 10 (12%) infants; late cranial ultrasound showed parenchymal abnormalities in 19 (30%) infants. Low-frequency MAP-HbD gain (highest quartile mean) was significantly associated with early GM/IVH but not other ultrasound findings. The most parsimonious model associated with early GM/IVH included only gestational age and MAP-HbD gain. This novel cerebrovascular monitoring technique allows quantification of cerebral pressure passivity as MAP-HbD gain in premature infants. We show that high MAP-HbD gain is significantly associated with GM/IVH. The precise temporal and causal relationship between MAP-HbD gain and GM/IVH awaits further study.
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影响因子：
8
作者：
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