Document Detail

Cerebral hemodynamic changes during intensive care of preterm infants.
MedLine Citation:
PMID:  18931348     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The objectives of this study were to examine the circulatory changes experienced by the immature systemic and cerebral circulations during routine events in the critical care of preterm infants and to identify clinical factors that are associated with greater hemodynamic-oxygenation changes during these events.
METHODS: We studied 82 infants who weighed <1500 g at birth and required intensive care management and continuous blood pressure monitoring from an umbilical arterial catheter. Continuous recording of cerebral and systemic hemodynamic and oxygenation changes was performed. We studied 6 distinct types of caregiving events during 10-minute epochs: (1) quiet baseline periods; (2) minor manipulation; (3) diaper changes; (4) endotracheal tube suctioning; (5) endotracheal tube repositioning; and (6) complex events. Each event was matched with a preceding baseline. We examined the effect of specific clinical factors and cranial ultrasound abnormalities on the systemic and cerebral hemodynamic oxygenation changes that were associated with the various event types.
RESULTS: There were highly significant differences in hemodynamics and oxygenation between events overall and baseline epochs. The magnitude of these circulatory changes was greatest during endotracheal tube repositioning and complex caregiving events. Lower gestational age, higher illness severity, chorioamnionitis, low Apgar scores, and need for pressor-inotropes all were associated with circulatory changes of significantly lower magnitude. Cerebral hemodynamic changes were associated with early parenchymal ultrasound abnormalities.
CONCLUSIONS: Routine caregiving procedures in critically ill preterm infants are associated with major circulatory fluctuations that are clinically underappreciated and underdetected by current bedside monitoring. Our data underscore the importance of continuous cerebral hemodynamic monitoring in critically ill preterm infants.
Catherine Limperopoulos; Kimberlee K Gauvreau; Heather O'Leary; Marianne Moore; Haim Bassan; Eric C Eichenwald; Janet S Soul; Steven A Ringer; Donald N Di Salvo; Adré J du Plessis
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2008-10-17
Journal Detail:
Title:  Pediatrics     Volume:  122     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-11-03     Completed Date:  2008-11-25     Revised Date:  2014-09-21    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e1006-13     Citation Subset:  AIM; IM    
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MeSH Terms
Blood Volume
Brain / physiology*
Cerebrovascular Circulation / physiology
Critical Care*
Health Status Indicators
Infant, Newborn
Infant, Premature / physiology*
Infant, Very Low Birth Weight
Intubation, Intratracheal
Multivariate Analysis
Oxyhemoglobins / analysis
Prospective Studies
Spectroscopy, Near-Infrared
Grant Support
K24 NS057568/NS/NINDS NIH HHS; K24 NS057568-01/NS/NINDS NIH HHS; K24 NS057568-02/NS/NINDS NIH HHS; P01NS38475/NS/NINDS NIH HHS; R21 HD056009/HD/NICHD NIH HHS; R21 HD056009-01/HD/NICHD NIH HHS; R21 HD056009-02/HD/NICHD NIH HHS
Reg. No./Substance:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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