Elevated Diastolic Closing Margin Is Associated with Intraventricular Hemorrhage in Premature Infants - 24/06/16
, Jeffrey R. Kaiser, MD, MA 1, 2, Danielle R. Rios, MD 1, Kathleen K. Kibler, CCP 3, 4, 5, R. Blaine Easley, MD 3, 4, 5, Dean B. Andropoulos, MD 3, 4, 5, Marek Czosnyka, PhD 6, Peter Smielewski, PhD 6, Georgios V. Varsos, PhD 6, Craig G. Rusin, PhD 7, C. Heath Gauss, MS 8, D. Keith Williams, PhD, MPH 8, Ken M. Brady, MD 3, 4, 5Abstract |
Objective |
To determine whether the diastolic closing margin (DCM), defined as diastolic blood pressure minus critical closing pressure, is associated with the development of early severe intraventricular hemorrhage (IVH).
Study design |
A reanalysis of prospectively collected data was conducted. Premature infants (gestational age 23-31 weeks) receiving mechanical ventilation (n = 185) had ∼1-hour continuous recordings of umbilical arterial blood pressure, middle cerebral artery cerebral blood flow velocity, and PaCO2 during the first week of life. Models using multivariate generalized linear regression and purposeful selection were used to determine associations with severe IVH.
Results |
Severe IVH (grades 3-4) was observed in 14.6% of the infants. Irrespective of the model used, Apgar score at 5 minutes and DCM were significantly associated with severe IVH. A clinically relevant 5-mm Hg increase in DCM was associated with a 1.83- to 1.89-fold increased odds of developing severe IVH.
Conclusion |
Elevated DCM was associated with severe IVH, consistent with previous animal data showing that IVH is associated with hyperperfusion. Measurement of DCM may be more useful than blood pressure in defining cerebral perfusion in premature infants.
Le texte complet de cet article est disponible en PDF.Keywords : arterial blood pressure, cerebral blood flow, critical closing pressure
Abbreviations : ABP, CBF, CBFV, CrCP, DCM, EGA, IVH, NICU
Plan
| J.K. was supported by the National Institutes of Health (1K23NS43185, RR20146, and 1R01NS060674) and the University of Arkansas for Medical Sciences Translational Research Institute (1UL1RR029884). C.R. is supported by the Chao Physician Scientist Award (Baylor College of Medicine, Houston, TX), an American Heart Association Grant (15MCPRP25670019), and by the National Institutes of Health (1K23NS091382-01A1). The authors declare no conflicts of interest. |
Vol 174
P. 52-56 - juillet 2016 Retour au numéro
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