Assessing key clinical parameters before and after intraventricular hemorrhage in very preterm infants

Renée Lampe,Laura Eckardt,Esther Rieger-Fackeldey,Andrey Kovtanyuk,Michael Schündeln,Nikolai Botkin,Irina Sidorenko,Ursula Felderhoff-Müser,Ana Alves-Pinto,Varvara Turova

doi:10.1007/s00431-020-03585-9

Abstract

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 (pCO2), 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 pCO2 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 pCO2 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.

Highlights

Intraventricular cerebral hemorrhage (IVH) is the most frequent cause of brain damage in preterm infants [1, 2], leadingRenée Lampe, Esther Rieger-Fackeldey, Irina Sidorenko and Varvara Turova contributed to this work
No written patient consent was necessary for this retrospective study because of the following: (1) this report does not contain any personal information that could lead to the identification of the patient; (2) all data analyzed were collected as the part of routine diagnosis and treatment; (3) patient medical care was not set up for research purposes, but was the part of standard clinical procedure; (4) all patients were diagnosed and treated according to national guidelines and agreements
The cohort consisted of 254 very preterm infants with a gestational age (GA) between 23 and 30 weeks gestation (26.5 ± 2.1) and a birth weight (BW) between 335 and 1580 g (864.1 ± 279.1 g)

Summary

Introduction

Intraventricular cerebral hemorrhage (IVH) is the most frequent cause of brain damage in preterm infants [1, 2], leadingRenée Lampe, Esther Rieger-Fackeldey, Irina Sidorenko and Varvara Turova contributed to this work. Intraventricular cerebral hemorrhage (IVH) is the most frequent cause of brain damage in preterm infants [1, 2], leading. IVH occurs with a frequency of 20– 25% [1, 2] in preterm born infants with a gestational age (GA) < 32 weeks and/or a birth weight (BW) < 1500 g. It occurs most often in the subependymal germinal matrix [6, 7], a highly vascularized neuroepithelial structure with fragile vessels, which remains a part of the developing brain until the 30th week of gestation (WG). The germinal matrix vessels have a larger diameter than in the cortex, and a larger wall tension, and are likely to rupture leading to cerebral hemorrhage

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