Brunsch Celina L, Lahr Bineta E, Kooi Elisabeth M W
Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands.
Pediatr Res. 2025 May 2. doi: 10.1038/s41390-025-04087-w.
Preterm neonates are vulnerable to impaired cerebrovascular autoregulation (CAR), with a risk of developing cerebral injury (intraventricular hemorrhage or periventricular leukomalacia). In this meta-analysis, we evaluate the association between the degree of CAR and cerebral injury in preterm neonates, using various CAR assessment techniques mainly based on near-infrared spectroscopy.
We systematically searched PubMed and EMBASE between 01-05-2023 and 31-01-2024. We included original articles published between 2000-2023, reporting CAR and cerebral injury in preterm neonates. The study was registered in PROSPERO (ID: 427323). We assessed the standardized mean difference in degree of CAR in groups with and without cerebral injury, with a subgroup analysis of CAR measurement techniques.
Seventeen articles were included, encompassing 742 patients. The overall standardized mean difference of 0.59 (95%CI 0.30, 0.88) indicates more impaired CAR in neonates with cerebral injury. Time-domain analysis produced the least heterogeneous and most significant difference of 0.61 (95%CI 0.24, 0.98). Limitations include differences in measurement techniques and a lack of randomized controlled trials.
This meta-analysis showed an association between CAR and cerebral injury, highlighting the clinical relevance of CAR assessment in preterm neonates. Future randomized studies using standardized measurement techniques should assess the feasibility of CAR-guided hemodynamic management.
Cerebral injury and adverse neurological outcomes are prevalent in preterm neonates. Historically, immature cerebrovascular autoregulation was thought to be one of the main causes of cerebral injury in this patient population. This is the first study to systematically review and synthetize robust evidence on the relation between cerebrovascular autoregulation and preterm brain injury. This meta-analysis further adds to the existing literature by comparing different cerebrovascular autoregulation measurement techniques. The findings can help to standardize cerebrovascular autoregulation assessment and implement it in clinical practice using large, randomized trials.
早产儿易出现脑血管自动调节功能（CAR）受损，有发生脑损伤（脑室内出血或脑室周围白质软化）的风险。在这项荟萃分析中，我们使用主要基于近红外光谱的各种CAR评估技术，评估早产儿CAR程度与脑损伤之间的关联。
我们在2023年5月1日至2024年1月31日期间系统检索了PubMed和EMBASE。我们纳入了2000年至2023年发表的报告早产儿CAR和脑损伤的原始文章。该研究已在PROSPERO注册（ID：427323）。我们评估了有脑损伤组和无脑损伤组CAR程度的标准化平均差异，并对CAR测量技术进行了亚组分析。
纳入了17篇文章，共742例患者。总体标准化平均差异为0.59（95%CI 0.30，0.88），表明脑损伤新生儿的CAR受损更严重。时域分析产生的异质性最小，差异最显著，为0.61（95%CI 0.24，0.98）。局限性包括测量技术的差异以及缺乏随机对照试验。
这项荟萃分析显示了CAR与脑损伤之间的关联，突出了CAR评估在早产儿中的临床相关性。未来使用标准化测量技术的随机研究应评估CAR指导的血流动力学管理的可行性。
脑损伤和不良神经结局在早产儿中很常见。从历史上看，不成熟的脑血管自动调节功能被认为是该患者群体脑损伤的主要原因之一。这是第一项系统回顾和综合关于脑血管自动调节与早产儿脑损伤关系的有力证据的研究。这项荟萃分析通过比较不同的脑血管自动调节测量技术，进一步丰富了现有文献。这些发现有助于标准化脑血管自动调节评估，并通过大型随机试验将其应用于临床实践。
