Neonatal Intensive Care Unit, IRCCS AOU S. Orsola, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Department of Neonatology, University Hospitals Leuven, Leuven, Belgium.
Pediatr Res. 2024 Sep;96(4):884-895. doi: 10.1038/s41390-023-02574-6. Epub 2023 Mar 30.
Cerebrovascular reactivity defines the ability of the cerebral vasculature to regulate its resistance in response to both local and systemic factors to ensure an adequate cerebral blood flow to meet the metabolic demands of the brain. The increasing adoption of near-infrared spectroscopy (NIRS) for non-invasive monitoring of cerebral oxygenation and perfusion allowed investigation of the mechanisms underlying cerebrovascular reactivity in the neonatal population, confirming important associations with pathological conditions including the development of brain injury and adverse neurodevelopmental outcomes. However, the current literature on neonatal cerebrovascular reactivity is mainly still based on small, observational studies and is characterised by methodological heterogeneity; this has hindered the routine application of NIRS-based monitoring of cerebrovascular reactivity to identify infants most at risk of brain injury. This review aims (1) to provide an updated review on neonatal cerebrovascular reactivity, assessed using NIRS; (2) to identify critical points that need to be addressed with targeted research; and (3) to propose feasibility trials in order to fill the current knowledge gaps and to possibly develop a preventive or curative approach for preterm brain injury. IMPACT: NIRS monitoring has been largely applied in neonatal research to assess cerebrovascular reactivity in response to blood pressure, PaCO and other biochemical or metabolic factors, providing novel insights into the pathophysiological mechanisms underlying cerebral blood flow regulation. Despite these insights, the current literature shows important pitfalls that would benefit to be addressed in a series of targeted trials, proposed in the present review, in order to translate the assessment of cerebrovascular reactivity into routine monitoring in neonatal clinical practice.
脑血管反应性定义了脑血管在响应局部和全身因素调节其阻力的能力，以确保足够的脑血流来满足大脑的代谢需求。近红外光谱（NIRS）在非侵入性监测脑氧合和灌注方面的应用越来越广泛，这使得人们能够研究新生儿人群中脑血管反应性的机制，证实了其与包括脑损伤和不良神经发育结果在内的病理状况的重要关联。然而，目前关于新生儿脑血管反应性的文献主要仍然基于小型观察性研究，并且具有方法学异质性；这阻碍了基于 NIRS 的脑血管反应性监测的常规应用，以识别最容易发生脑损伤的婴儿。本综述旨在：(1) 提供使用 NIRS 评估的新生儿脑血管反应性的最新综述；(2) 确定需要通过针对性研究解决的关键点；(3) 提出可行性试验，以填补当前知识空白，并可能为早产儿脑损伤开发预防或治疗方法。
NIRS 监测已广泛应用于新生儿研究中，以评估血压、PaCO2 和其他生化或代谢因素对脑血管反应性的影响，为脑血流调节的病理生理机制提供了新的见解。尽管有这些见解，但当前的文献显示出重要的缺陷，这些缺陷可以通过本综述中提出的一系列有针对性的试验来解决，以便将脑血管反应性的评估转化为新生儿临床实践中的常规监测。
