Bradycardia and hypoxaemia due to position-dependent hypoperfusion of the brain stem in a preterm infant.
The case is reported of a male baby with a decreased time average velocity of the basilar artery to 32%, measured by Doppler sonography in dextro-rotated head position. The decrease was due to a hypoplastic right vertebral artery with compression of the contralateral vertebral artery at the craniocervical junction during dextro-rotation of the head. This finding was more prominent in prone than in supine position. A decrease in oxygen saturation and heart rate to < 70% and 60 bpm, respectively, was monitored during dextro-rotation. The polysomnography also revealed postural-dependent bradycardia, decrease of the oxygen saturation, and rising carbon dioxide partial tension in prone position with dextro-rotation of the head.


CONCLUSIONS
Hypoperfusion of the brain stem caused by postural changes leads to further clinically relevant changes. Therefore an association with an acute life-threatening event and sudden infant death syndrome is speculated.
Vogelberg
C
C
Department of Paediatrics, University Hospital, Dresden, Germany. christian.vogelberg@mailbox.tu-dresden.de
Taut-Sack
H
H
Friebel
D
D
Maier
U
U
Rupprecht
E
E
D001488:Basilar Artery / Q000000981:diagnostic imaging; D001783:Blood Flow Velocity / Q000502:physiology; D001919:Bradycardia / Q000209:etiology*; D001933:Brain Stem / Q000098:blood supply*; D007839:Functional Laterality / Q000502:physiology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D000860:Hypoxia / Q000209:etiology* / Q000378:metabolism; D007231:Infant, Newborn; D007234:Infant, Premature; D010100:Oxygen / Q000378:metabolism; D017286:Polysomnography; D011187:Posture; D016684:Prone Position; D016683:Supine Position; D018608:Ultrasonography, Doppler / Q000379:methods; D014711:Vertebral Artery / Q000000981:diagnostic imaging
D010100:Oxygen