Al Kanjo Mohamed, McNamara Patrick J, Czech Theresa M, Lee Stephanie S, Momany Allison M, Rios Danielle R
Division of Neonatology, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA.
Division of Neurology, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA.
J Perinatol. 2025 Jul;45(7):935-943. doi: 10.1038/s41372-025-02357-3. Epub 2025 Jul 18.
The relationship between systemic hemodynamics and cerebral perfusion in neonates, particularly those with systemic hypotension, is complex and not clearly elucidated. Targeted neonatal echocardiography (TNE) provides valuable insights into cerebral hemodynamics by quantifying middle cerebral artery (MCA) flow in the context of systemic hemodynamics.
To investigate the correlation between blood pressure (BP), cardiac output (CO), and MCA Doppler indices in neonates, hypothesizing that BP alone is not a reliable measure of cerebral perfusion.
A retrospective cohort study of neonates who underwent their first TNE in the Neonatal Intensive Care Unit. The analysis focused on the relationship between BP components and MCA Doppler measures (i.e., resistive index and pulsatility index).
The study included 194 neonates born at a mean gestational age and weight of 30.7 ± 6 weeks and 1744 ± 1246 g, respectively, classified into normotensive, hypotensive, and normotensive-treated groups. Weak correlations were observed between MCA Doppler measures and BP components across the entire cohort. Group comparisons found that neonates in the hypotensive group exhibited higher MCA-RI compared to both normotensive and normotensive-treated groups. Exploratory analyses revealed significant variation in MCA-RI that was explained by cardiac output after accounting for BP and gestational age.
These findings suggest that BP alone is not a sufficient indicator of cerebral perfusion status. While the correlations were expected to be weak given the dynamic nature of cardiac output, the results highlight the need for comprehensive hemodynamic assessments in neonates with cardiovascular compromise to avoid reliance on oversimplified metrics such as BP versus Dopplers.
新生儿尤其是患有系统性低血压的新生儿，其全身血流动力学与脑灌注之间的关系复杂且尚未完全阐明。靶向新生儿超声心动图（TNE）通过在全身血流动力学背景下量化大脑中动脉（MCA）血流，为脑血流动力学提供了有价值的见解。
研究新生儿血压（BP）、心输出量（CO）与MCA多普勒指数之间的相关性，假设仅血压不是脑灌注的可靠指标。
对在新生儿重症监护病房接受首次TNE的新生儿进行回顾性队列研究。分析重点关注血压成分与MCA多普勒测量值（即阻力指数和搏动指数）之间的关系。
该研究纳入了194例新生儿，其平均胎龄和体重分别为30.7±6周和1744±1246g，分为正常血压组、低血压组和正常血压治疗组。在整个队列中，观察到MCA多普勒测量值与血压成分之间存在弱相关性。组间比较发现，低血压组新生儿的MCA-RI高于正常血压组和正常血压治疗组。探索性分析显示，在考虑血压和胎龄后，心输出量可解释MCA-RI的显著差异。
这些发现表明，仅血压不足以作为脑灌注状态的指标。鉴于心输出量的动态性质，预计相关性较弱，但结果强调了对有心血管损害的新生儿进行全面血流动力学评估的必要性，以避免依赖诸如血压与多普勒等过于简化的指标。
