Development of Cerebral Autoregulation in VLBW Infants

极低体重婴儿大脑自动调节的发展

• 批准号: 7054699
• 负责人: JEFFREY Radin KAISER
• 金额: $ 17.3万
• 依托单位: UNIV OF ARKANSAS FOR MED SCIS
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-05-01 至 2007-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7054699
• 关键词: blood pressure; brain circulation; brain injury; clinical research; developmental neurobiology; gestational age; hemodynamics; heterodyning; human subject; low birth weight infant human; mathematical model; neonatal intensive care; neurogenesis; neuroregulation; newborn human (0-6 weeks); pathologic process; patient monitoring device; postnatal growth disorder; premature infant human; respiratory gas; trachea; ultrasonography

This proposal outlines a program to study the development of cerebral autoregulation in very low birth weight (VLBW) (501-1500 grams birth weight) infants, and its role in brain injury. Despite improvements in intensive care, brain injury in VLBW infants remains a significant health problem. This is due to the increasing incidence of prematurity and increasing survival rates of VLBW infants most prone to developing intraventricular hemorrhage. Overwhelming evidence suggests that disturbances of autoregulation are important in the pathogenesis of these injuries. Autoregulation is a mechanism that maintains constant blood flow to the brain despite wide variations in postnatal ages, little is known about how autoregulation develops in VLBW infants. A novel integrated monitoring system will be used to test the central hypotheses that cerebral autoregulatory capacity in VLBW infants is developmentally acquired and its disruption is associated with brain injury. The ontogenetic profile of autoregulatory capacity in VLBW infants will be determined. In those who lack autoregulation, the postnatal time course for development will be assessed. Then the relationship between the absence of autoregulation and brain injury will be established. Two hundred VLBW infants who have normal finding on a cranial ultrasound on day of life 1 will be enrolled. Continuous 1-hour measurements of cerebral blood flow velocity (transcranial Doppler ultrasound) will be compared to simultaneous blood pressure measurements using multivariate analysis, after adjusting for variations in arterial blood gases (continuous blood gas monitor), to determine autoregulatory capacity (twice daily during the first 3 days of life and one on days 4-7). Data will be analyzed for each individual and for gestational age (23-25, 26-28, and greater than or equal to 29 weeks'; full term is 37-42 weeks') groups. Results from this study will help us recognized when VLBW infants are most vulnerable to developing brain injury, allowing prevention and intervention strategies to be initiated in a timely fashion. Dr. Jeffrey R. Kaiser will take advantage of the strong mentoring, protected research time and outstanding academic resources of the University of Arkansas for Medical Sciences to reach his goal of becoming an independent investigator.

该提案概述了一项研究极低出生体重 (VLBW)（501-1500 克出生体重）婴儿大脑自动调节发育及其在脑损伤中的作用的计划。尽管重症监护有所改善，极低出生体重婴儿的脑损伤仍然是一个重大的健康问题。这是由于早产发生率增加以及最容易发生脑室内出血的极低出生体重婴儿的存活率增加。压倒性的证据表明，自动调节紊乱在这些损伤的发病机制中很重要。尽管出生后年龄差异很大，但自动调节是一种维持大脑恒定血流的机制，但人们对极低出生体重婴儿的自动调节如何发展知之甚少。一种新颖的综合监测系统将用于测试中心假设，即极低出生体重婴儿的大脑自动调节能力是发育获得的，其破坏与脑损伤有关。将确定极低出生体重婴儿的自身调节能力的个体发育特征。对于那些缺乏自我调节的人，将评估出生后的发育时间过程。然后，自动调节缺失与脑损伤之间的关系就会成立。将纳入 200 名出生后第一天颅脑超声检查结果正常的 VLBW 婴儿。在调整动脉血气变化（连续血气监测仪）后，将连续 1 小时的脑血流速度测量（经颅多普勒超声）与使用多变量分析的同时血压测量进行比较，以确定自动调节能力（在生命的前 3 天每天两次，第 4-7 天每天一次）。将对每个个体和胎龄（23-25、26-28 和大于或等于 29 周；足月为 37-42 周）组进行数据分析。这项研究的结果将帮助我们识别极低出生体重婴儿何时最容易发生脑损伤，从而及时启动预防和干预策略。 Jeffrey R. Kaiser 博士将利用阿肯色医学大学强有力的指导、受保护的研究时间和优秀的学术资源来实现成为一名独立研究者的目标。

项目成果

Hypotension and brain injury in premature infants.

早产儿的低血压和脑损伤。

• DOI: 10.1542/peds.2007-3602
• 发表时间: 2008
• 期刊: Pediatrics
• 影响因子: 8
• 作者: Hall,RichardW;Kaiser,JeffreyR
• 通讯作者: Kaiser,JeffreyR

The effects of closed tracheal suctioning plus volume guarantee on cerebral hemodynamics.

• DOI: 10.1038/jp.2011.8
• 发表时间: 2011-10
• 期刊: JOURNAL OF PERINATOLOGY
• 影响因子: 2.9
• 作者: Kaiser, J. R.;Gauss, C. H.;Williams, D. K.
• 通讯作者: Williams, D. K.

Impaired white matter development in extremely low-birth-weight infants with previous brain hemorrhage.

• DOI: 10.3174/ajnr.a3988
• 发表时间: 2014-10
• 期刊: AJNR. American journal of neuroradiology
• 作者: Ou X;Glasier CM;Ramakrishnaiah RH;Mulkey SB;Ding Z;Angtuaco TL;Andres A;Kaiser JR
• 通讯作者: Kaiser JR

The Ontogeny of Cerebrovascular Critical Closing Pressure.

脑血管临界闭合压的个体发生。

• DOI: 10.1007/978-3-319-22533-3_50
• 发表时间: 2016
• 期刊: Acta neurochirurgica. Supplement
• 作者: Rhee,ChristopherJ;Fraser3rd,CharlesD;Kibler,Kathleen;Easley,RonaldB;Andropoulos,DeanB;Czosnyka,Marek;Varsos,GeorgiosV;Smielewski,Peter;Rusin,CraigG;Brady,KenM;Kaiser,JeffreyR
• 通讯作者: Kaiser,JeffreyR

Diffusion tensor imaging in extremely low birth weight infants managed with hypercapnic vs. normocapnic ventilation.

采用高碳酸血症与正常碳酸血症通气治疗的极低出生体重婴儿的弥散张量成像。

• DOI: 10.1007/s00247-014-2946-8
• 发表时间: 2014-08
• 期刊: PEDIATRIC RADIOLOGY
• 影响因子: 2.3
• 作者: Ou, Xiawei;Glasier, Charles M.;Ramakrishnaiah, Raghu H.;Angtuaco, Teresita L.;Mulkey, Sarah B.;Ding, Zhaohua;Kaiser, Jeffrey R.
• 通讯作者: Kaiser, Jeffrey R.