Observed and calculated cerebral critical closing pressure are highly correlated in preterm infants.

Authors:
Danielle R Rios
Danielle R Rios
Baylor College of Medicine
United States
Eric Vu
Eric Vu
Texas Children's Hospital
Houston | United States
Kathleen Kibler
Kathleen Kibler
Baylor College of Medicine
Grapevine | United States
Dean B Andropoulos
Dean B Andropoulos
Texas Children's Hospital
United States
Sebastian Acosta
Sebastian Acosta
Texas Children's Hospital
United States
Craig G Rusin
Craig G Rusin
University of Virginia

Pediatr Res 2019 Apr 19. Epub 2019 Apr 19.

Department of Pediatrics, Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.

Background: Cerebrovascular critical closing pressure (CrCP) is the arterial blood pressure (ABP) at which cerebral blood flow ceases. Preterm ABP is low and close to CrCP. The diastolic closing margin (diastolic ABP minus CrCP) has been associated with intraventricular hemorrhage in preterm infants. CrCP is estimated from middle cerebral artery cerebral blood flow velocity (CBFV) and ABP waveforms. However, these estimations have not been validated due to a lack of gold standard. Direct observation of the CrCP in preterm infants with hypotension is an opportunity to validate synchronously estimated CrCP.

Methods: ABP and CBFV tracings were obtained from 24 extremely low birth weight infants. Recordings where diastolic CBFV was zero were identified. The gold standard CrCP was delineated using piecewise regression of ABP and CBFV values paired by rank ordering and then estimated using a published formula. The measured and estimated values were compared using linear regression and Bland-Altman analysis.

Results: Linear regression showed a high degree of correlation between measured and calculated CrCP (r = 0.93).

Conclusions: This is the first study to validate a calculated CrCP by comparing it to direct measurements of CrCP from preterm infants when ABP is lower than CrCP.

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http://dx.doi.org/10.1038/s41390-019-0403-yDOI Listing
April 2019
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