Monitoring of cerebral haemodynamics in newborn infants.
The most important cerebrovascular injuries in newborn infants, particularly in preterm infants, are cerebral haemorrhage and ischemic injury. The typical cerebral vascular anatomy and the disturbance of cerebral haemodynamics play important roles in the pathophysiology. The term 'cerebral haemodynamics' includes cerebral blood flow (CBF), cerebral blood flow velocity, and cerebral blood volume (CBV). Therapy aimed at changing vascular anatomy is not available. Therefore, prevention of disturbances in CBF and CBV is pivotal. However, continuous monitoring of CBF and CBV is still unavailable for clinical use. Tissue oxygenation may be used as a surrogate for CBF, although precision is still questionable. General knowledge of the regulation of CBF and CBV is important. Although this knowledge is still incomplete, especially regarding autoregulation and the exact role of CBV, it is still useful. Using it even without knowing the exact level of CBF and CBV, it is possible to aim to keep CBF and CBV stable. Future research should focus on development of monitoring tools, gaining more insight in neonatal cerebral autoregulation, and demonstrating clinical benefits of a 'cerebral perfusion-oriented' therapy.
Liem
K Djien
KD
Department of Neonatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. d.liem@cukz.umcn.nl
Greisen
Gorm
G
D001783:Blood Flow Velocity / Q000502:physiology*; D001921:Brain / Q000098:blood supply*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D006801:Humans; D007231:Infant, Newborn / Q000502:physiology*; D017410:Practice Guidelines as Topic; D019265:Spectroscopy, Near-Infrared / Q000379:methods*; D018608:Ultrasonography, Doppler / Q000379:methods*