School of Medicine, Klinikum rechts der Isar, Orthopedic Department, Research Unit for Pediatric Neuroorthopedics and Cerebral Palsy of the Buhl-Strohmaier Foundation, Technical University of Munich, Ismaningerstr 22, 81675, Munich, Germany.
School of Medicine, Klinikum rechts der Isar, Department of Pediatrics, Technical University of Munich, Ismaningerstr 22, 81675, Munich, Germany.
Eur J Pediatr. 2020 Jun;179(6):929-937. doi: 10.1007/s00431-020-03585-9. Epub 2020 Jan 28.
Intraventricular cerebral hemorrhage (IVH) is one of the most severe complications of premature birth, potentially leading to lifelong disability. The purpose of this paper is the assessment of the evolution of three of the most relevant parameters, before and after IVH: mean arterial pressure (MAP), arterial carbon dioxide pressure (pCO), and cerebral blood flow (CBF). Clinical records of 254 preterm infants with a gestational age of 23-30 weeks, with and without a diagnosis of IVH, were reviewed for MAP and arterial pCO in the period up to 7 days before and 3 days after IVH or during the first 10 days of life in cases without IVH.Conclusion: A statistically significant increase in pCO and decrease in MAP in patients with IVH compared with those without were detected. Both the mean values and the mean absolute deviations of CBF were computed in this study, and the latter was significantly higher than in control group. High deviations of CBF, as well as hypercapnia and hypotension, are likely to contribute to the rupture of cerebral blood vessels in preterm infants, and consequently, to the development of IVH.What is Known:• The origin of IVH is multifactorial, but mean arterial pressure, carbon dioxide partial pressure, and cerebral blood flow are recognized as the most important parameters.• In premature infants, the autoregulation mechanisms are still underdeveloped and cannot compensate for cerebral blood flow fluctuations.What is New:• The numerical simulation of CBF is shown to be a promising approach that may be useful in the care of preterm infants.• The mean values of CBF before and after IVH in the affected group were similar to those in the control group, but the mean absolute deviations of CBF in the affected group before and after IVH were significantly higher than that in the control group.
脑室内出血（IVH）是早产儿最严重的并发症之一，可能导致终身残疾。本文旨在评估 IVH 前后三个最重要参数的变化：平均动脉压（MAP）、动脉二氧化碳分压（pCO2）和脑血流（CBF）。对 254 名胎龄 23-30 周的早产儿的临床记录进行了回顾性分析，这些早产儿患有或未患有 IVH，记录了 IVH 前 7 天和后 3 天或无 IVH 时生命的前 10 天内的 MAP 和动脉 pCO2。结论：与无 IVH 的患儿相比，IVH 患儿的 pCO2显著升高，MAP 显著降低。本研究还计算了 CBF 的平均值和平均绝对偏差，后者明显高于对照组。高 CBF 偏差以及高碳酸血症和低血压可能导致早产儿脑血管破裂，进而导致 IVH 的发生。已知：• IVH 的病因是多因素的，但平均动脉压、二氧化碳分压和脑血流被认为是最重要的参数。• 早产儿的自动调节机制尚未完全发育，无法补偿脑血流波动。新发现：• CBF 的数值模拟显示是一种很有前途的方法，可能对早产儿的护理有用。• 受影响组在 IVH 前后的 CBF 平均值与对照组相似，但受影响组在 IVH 前后的 CBF 平均绝对偏差明显高于对照组。
