Cerebral blood flow assessment of preterm infants during respiratory therapy with the expiratory flow increase technique

Mariana Almada Bassani,Jamil Pedro Siqueira Caldas,Abimael Aranha Netto,Sérgio Tadeu Martins Marba

doi:10.1016/j.rppede.2016.02.007

Mariana Almada Bassani, Jamil Pedro Siqueira Caldas + Show 2 more

Open Access

https://doi.org/10.1016/j.rppede.2016.02.007

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Abstract

ObjectiveTo assess the impact of respiratory therapy with the expiratory flow increase technique on cerebral hemodynamics of premature newborns. MethodsThis is an intervention study, which included 40 preterm infants (≤34 weeks) aged 8–15 days of life, clinically stable in ambient air or oxygen catheter use. Children with heart defects, diagnosis of brain lesion and/or those using vasoactive drugs were excluded. Ultrasonographic assessments with transcranial Doppler flowmetry were performed before, during and after the increase in expiratory flow session, which lasted 5min. Cerebral blood flow velocity and resistance and pulsatility indices in the pericallosal artery were assessed. ResultsRespiratory physical therapy did not significantly alter flow velocity at the systolic peak (p=0.50), the end diastolic flow velocity (p=0.17), the mean flow velocity (p=0.07), the resistance index (p=0.41) and the pulsatility index (p=0.67) over time. ConclusionsThe expiratory flow increase technique did not affect cerebral blood flow in clinically-stable preterm infants.

Highlights

The control of cerebral blood flow (CBF) involves complex neural and metabolic mechanisms, which are still immature in preterm newborns (PTNB).[1]
These children show a failure in the autoregulation of the CBF, which is directly dependent on blood pressure and has a pattern known as pressure passive
The objective of this study was to assess the influence of physiotherapy on the CBF in clinically-stable preterm newborns

Summary

Introduction

The control of cerebral blood flow (CBF) involves complex neural and metabolic mechanisms, which are still immature in preterm newborns (PTNB).[1] these children show a failure in the autoregulation of the CBF, which is directly dependent on blood pressure and has a pattern known as pressure passive. Newborns in intensive care are more likely to have CBF fluctuations, which increases the risk of hemorrhagic and ischemic cerebrovascular lesions, such as peri-intraventricular hemorrhage (PIVH) and periventricular leukomalacia (PVL), respectively. These neurological diseases may cause permanent motor sequelae of varying degrees, depending on the lesion extent, as well as cognitive, behavioral and intellectual disorders.1,3---5

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