Department of Neonatal Medicine, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan.
Department of Pediatrics, Tokai University School of Medicine, Isehara-shi, Japan.
Pediatr Res. 2014 Feb;75(2):322-7. doi: 10.1038/pr.2013.215. Epub 2013 Nov 20.
Cardiovascular instability immediately after birth is associated with intraventricular hemorrhage (IVH) in very-low-birth-weight (VLBW) infants. For circulatory management, evaluation of organ blood flow is important. In this study, the relationship between peripheral perfusion within 48 h after birth and IVH was evaluated in VLBW infants.
In this prospective observational study involving 83 VLBW infants, forehead blood flow (FBF) and lower-limb blood flow (LBF) were measured for 48 h after birth using a laser Doppler flowmeter. Blood flow was compared between infants with and without IVH. Multivariate logistic regression analysis was performed to identify the risk factors for IVH.
IVH developed in nine infants. In eight of these patients, IVH occurred after 24 h. LBF was lower in infants with IVH at 18 and 24 h and increased to the same level as that of infants without IVH at 48 h. Multivariate logistic regression analysis identified a correlation only between LBF and IVH at 18 h.
These findings were consistent with the hypoperfusion-reperfusion theory, which states that IVH develops after reperfusion subsequent to hypoperfusion. We speculate that measurement of skin blood flow in addition to systemic and cerebral circulation may be helpful in predicting IVH.
极低出生体重儿（VLBW）出生后即刻心血管不稳定与脑室内出血（IVH）有关。在循环管理中，评估器官血流很重要。本研究评估了 VLBW 婴儿出生后 48 小时内外周灌注与 IVH 的关系。
本前瞻性观察研究纳入了 83 名 VLBW 婴儿，使用激光多普勒流量计测量出生后 48 小时内的额部血流（FBF）和下肢血流（LBF）。比较了有和无 IVH 婴儿的血流。采用多变量逻辑回归分析确定 IVH 的危险因素。
9 名婴儿发生 IVH。其中 8 例在 24 小时后发生 IVH。IVH 组婴儿在 18 小时和 24 小时的 LBF 较低，在 48 小时时增加到与无 IVH 组相同的水平。多变量逻辑回归分析仅显示 LBF 与 18 小时的 IVH 相关。
这些发现与再灌注后低灌注再灌注理论一致，即 IVH 发生在低灌注后再灌注之后。我们推测，除了系统和脑循环外，测量皮肤血流可能有助于预测 IVH。
