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Cerebral Oxygenation Is Highly Sensitive to Blood Pressure Variability in Sick Preterm Infants

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  • Flora Y Wong
  • Reshma Silas
  • Simon Hew
  • Thilini Samarasinghe
  • Adrian M Walker

Abstract

Objectives: The significance of blood pressure variability (BPV) for cerebral oxygenation in extremely preterm infants has not been explored, though BPV may well be associated with end organ injury. We hypothesized that increased BPV in sick preterm infants, by exceeding the cerebral autoregulatory capacity, is associated with cerebral oxygenation changes which closely follow the blood pressure fluctuations. We assessed the autoregulatory capacity in the early postnatal period, by determining the correlation between BPV (mmHg2) and coherence of mean arterial blood pressure (MABP mmHg) and cerebral oxygenation (tissue oxygenation index, TOI %). Study Design: Thirty-two preterm infants of mean gestational age of 26.3 (±1.5) weeks were studied on the first 3 postnatal days. Spectral analysis (Coherence and transfer-function gain analysis) was used to calculate coherence of MABP and TOI; BPV was quantified using power spectral density of MABP. Results: Overall, maximum Coherence showed a trend for positive correlation with BPV (n = 32, p = 0.06). Infants identified as clinically unstable with documented brain injury (n = 7) had high Coherence values at low BPV. Separate analysis of stable infants (excluding the 7 critically ill infants) revealed a significant association between maximum Coherence and BPV (n = 25, p = 0.006). Conclusions: Fluctuation in cerebral oxygenation is closely associated with increased BPV in preterm infants undergoing intensive care. Moreover, in the critically sick preterm infant, blood pressure-dependent variations in cerebral oxygenation occur even with relatively lower BPV, suggesting they have severely impaired autoregulation, and placing them at greater vulnerability to cerebral injury arising from blood pressure fluctuations.

Suggested Citation

  • Flora Y Wong & Reshma Silas & Simon Hew & Thilini Samarasinghe & Adrian M Walker, 2012. "Cerebral Oxygenation Is Highly Sensitive to Blood Pressure Variability in Sick Preterm Infants," PLOS ONE, Public Library of Science, vol. 7(8), pages 1-7, August.
  • Handle: RePEc:plo:pone00:0043165
    DOI: 10.1371/journal.pone.0043165
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    Cited by:

    1. Kristen Tgavalekos & Thao Pham & Nishanth Krishnamurthy & Angelo Sassaroli & Sergio Fantini, 2019. "Frequency-resolved analysis of coherent oscillations of local cerebral blood volume, measured with near-infrared spectroscopy, and systemic arterial pressure in healthy human subjects," PLOS ONE, Public Library of Science, vol. 14(2), pages 1-27, February.
    2. Bertan Hallacoglu & Angelo Sassaroli & Sergio Fantini, 2013. "Optical Characterization of Two-Layered Turbid Media for Non-Invasive, Absolute Oximetry in Cerebral and Extracerebral Tissue," PLOS ONE, Public Library of Science, vol. 8(5), pages 1-15, May.

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