Neuropediatrics 2003; 34(6): 281-286
DOI: 10.1055/s-2003-44663
Original Article

Georg Thieme Verlag Stuttgart · New York

The Development of Cerebral Perfusion in Healthy Preterm and Term Neonates

M. Kehrer 1 , 2 , I. Krägeloh-Mann 1 , R. Goelz 2 , M. Schöning 1
  • 1Department of Child Neurology, University Children's Hospital, Tübingen, Germany
  • 2Department of Neonatology, University Children's Hospital, Tübingen, Germany
Further Information

Publication History

Received: March 27, 2003

Accepted after Revision: July 27, 2003

Publication Date:
18 December 2003 (online)

Abstract

Quantitative measurement of cerebral blood flow (CBF) volume was performed by sonographic flowmetry of both internal carotid (ICA) and vertebral arteries (VA) in 113 healthy preterm and term infants of 32 - 42 weeks postmenstrual age (PA) in order to delineate the physiological characteristics of brain perfusion in a time period very sensitive to brain injury. Mean CBF volume increased with PA, beginning with 33 ± 9 ml/min in neonates of 32 - 34 weeks and rising to 45 ± 10, 58 ± 13, 69 ± 14, and 83 ± 16 ml/min, respectively, in the PA groups of 35 - 36, 37 - 38, 39 - 40 and 41 - 42 weeks. There was no difference in CBF volume between the sexes. The bilateral sum of flow volumes in both ICA and VA rose markedly with PA. The relative contribution of bilateral VA flow volume to total CBF volume was 26 ± 8 % and remained constant with PA. In addition, we calculated the approximate CBF (ml/100 g brain weight/min) using the brain weights of each child as estimated by means of an equation based on head circumference measurements. Estimated CBF correlated significantly with PA (r = 0.49; p ≤ 0.0001), reflecting the rising metabolic demand of the growing brain during the time period examined.

References

  • 1 Adcock L M, Wafelman L S, Hegemier S, Moise A A, Speer M E, Contant C F. et al . Neonatal intensive care applications of near-infrared spectroscopy.  Clin Perinatol. 1999;  26 893-903
  • 2 Altman D I, Powers W J, Perlman J M, Herscovitch P, Volpe S L, Volpe J J. Cerebral blood flow requirement for brain viability in newborn infants is lower than in adults.  Ann Neurol. 1988;  24 218-226
  • 3 Altman D I, Perlman J M, Volpe J J, Powers W J. Cerebral oxygen metabolism in newborns.  Pediatrics. 1993;  92 99-104
  • 4 Børch K, Greisen G. Blood flow distribution in the normal human preterm brain.  Pediatr Res. 1998;  43 28-33
  • 5 Chiron C, Raynaud C, Maziere B, Zilbovicius M, Laflamme L, Masure M C. et al . Changes in regional cerebral blood flow during brain maturation in children and adolescents.  J Nucl Med. 1992;  33 696-703
  • 6 Dekaban A S, Sadowsky D. Changes in brain weights during the span of human life: relation of brain weights to body heights and body weights.  Ann Neurol. 1978;  4 345-356
  • 7 Dobbing J, Sands J. Quantitative growth and development of human brain.  Arch Dis Child. 1973;  48 757-767
  • 8 Dörfler P, Puls I, Schließer M, Mäurer M, Becker G. Measurement of cerebral blood flow volume by extracranial sonography.  J Cereb Blood Flow Metab. 2000;  20 269-271
  • 9 Edwards A D, Wyatt J S, Richardson C, Delpy D T, Cope M, Reynolds E OR. Cotside measurement of cerebral blood flow in ill newborn infants by near infrared spectroscopy.  Lancet. 1988;  2 770-771
  • 10 Edwards A D, Wyatt J S, Richardson C E, Delpy D T, Cope M, Reynolds E OR. Precision of cerebral blood flow measurement by near infrared spectroscopy.  Pediatr Res. 1989;  26 520
  • 11 Greisen G. Cerebral blood flow in preterm infants during the first week of life.  Acta Paediatr Scand. 1986;  75 43-51
  • 12 Greisen G, Trojaborg W. Cerebral blood flow, PaCO2 changes, and visual evoked potentials in mechanically ventilated, preterm infants.  Acta Paediatr Scand. 1987;  76 394-400
  • 13 Ho K-C, Roessmann U, Hause L, Monroe G. Newborn brain weight in relation to maturity, sex, and race.  Ann Neurol. 1981;  10 243-246
  • 14 Hüppi P S, Warfield S, Kikinis R, Barnes P D, Zientara G P, Jolesz F A. et al . Quantitative magnetic resonance imaging of brain development in premature and mature newborns.  Ann Neurol. 1998;  43 224-235
  • 15 Jordaan H V, Sattar F A, Shah P, Makarachi A. Simplified method of determining fetal brain weight in utero.  Obstet Gynecol. 1980;  55 673-677
  • 16 Kehrer M, Goelz R, Krägeloh-Mann I, Schöning M. Measurement of volume of cerebral blood flow in healthy preterm and term neonates with ultrasound.  Lancet. 2002;  360 1749-1750
  • 17 Kinnala A, Suhonen-Polvi H, Äärimaa T, Kero P, Korvenranta H, Ruotsalainen U. et al . Cerebral metabolic rate for glucose during the first six months of life: an FDG positron emission tomography study.  Arch Dis Child. 1996;  74 F153-F157
  • 18 Krägeloh-Mann I, Toft P, Lunding J, Andresen J, Pryds O, Lou H C. Brain lesions in preterms: origin, consequences and compensation.  Acta Paediatr. 1999;  88 897-908
  • 19 Lassen N A. Normal average value of cerebral blood flow in younger adults is 50 ml/100 g/min.  J Cereb Blood Flow Metab. 1985;  5 347-349
  • 20 Patel J, Marks K, Roberts I, Azzopardi D, Edwards A D. Measurement of cerebral blood flow in newborn infants using near infrared spectroscopy with indocyanine green.  Pediatr Res. 1998;  43 34-39
  • 21 Pryds O, Greisen G. Effect of PaCO2 and haemoglobin concentration on day to day variation of CBF in preterm neonates.  Acta Paediatr Scand Suppl. 1989;  360 33-36
  • 22 Pryds O, Edwards A D. Cerebral blood flow in the newborn infant.  Arch Dis Child Fetal Neonatal Ed. 1996;  74 F63-F69
  • 23 Scheel P, Ruge C, Petruch U R, Schöning M. Color duplex measurement of cerebral blood flow volume in healthy adults.  Stroke. 2000;  31 147-150
  • 24 Schöning M, Walter J, Scheel P. Estimation of cerebral blood flow through color duplex sonography of the carotid and vertebral arteries in healthy adults.  Stroke. 1994;  25 17-22
  • 25 Schöning M, Scheel P. Color duplex measurement of cerebral blood flow volume: intra-and interobserver reproducibility and habituation to serial measurements in normal subjects.  J Cereb Blood Flow Metab. 1996;  16 523-531
  • 26 Schöning M, Hartig B. Age dependence of total cerebral blood flow volume from childhood to adulthood.  J Cereb Blood Flow Metab. 1996;  16 827-833
  • 27 Soul J S, Taylor G A, Wypij D, Duplessis A J, Volpe J J. Noninvasive detection of changes in cerebral blood flow by near-infrared spectroscopy in a piglet model of hydrocephalus.  Pediatr Res. 2000;  48 445-449
  • 28 Tsuji M, Duplessis A, Taylor G, Crocker R, Volpe J J. Near infrared spectroscopy detects cerebral ischemia during hypotension in piglets.  Pediatr Res. 1998;  44 591-595
  • 29 Tsuji M, Saul J P, du Plessis A, Eichenwald E, Sobh J, Crocker R. et al . Cerebral intravascular oxygenation correlates with mean arterial pressure in critically ill premature infants.  Pediatrics. 2000;  106 625-632
  • 30 Volpe J J, Herscovitch P, Perlman J M, Kreusser K L, Raichle M E. Positron emission tomography in the asphyxiated term newborn: parasagittal impairment of cerebral blood flow.  Ann Neurol. 1985;  17 287-296
  • 31 Volpe J J. Neurology of the Newborn. 4th ed. Philadelphia; WB Saunders 2001
  • 32 Yoxall C W, Weindling A M. Measurement of cerebral oxygen consumption in the human neonate using near infrared spectroscopy: cerebral oxygen consumption increases with advancing gestational age.  Pediatr Res. 1998;  44 283-290

M. D. Martin Schöning

Department of Child Neurology
University Children's Hospital

Hoppe-Seyler-Straße 1

72076 Tübingen

Germany

Email: martin.schoening@med.uni-tuebingen.de

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