Elevated Diastolic Closing Margin Is Associated with Intraventricular Hemorrhage in Premature Infants
Objective To determine whether the diastolic closing margin (DCM), defined as diastolic blood pressure minus critical closing pressure, is associated with the development of early severe intraventricular hemorrhage (IVH). Study design A reanalysis of prospectively collected data was conducted. Prema...
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| Published in | The Journal of pediatrics Vol. 174; pp. 52 - 56 |
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| Main Authors | , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
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Elsevier Inc
01.07.2016
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| Abstract | Objective To determine whether the diastolic closing margin (DCM), defined as diastolic blood pressure minus critical closing pressure, is associated with the development of early severe intraventricular hemorrhage (IVH). Study design A reanalysis of prospectively collected data was conducted. Premature infants (gestational age 23-31 weeks) receiving mechanical ventilation (n = 185) had ∼1-hour continuous recordings of umbilical arterial blood pressure, middle cerebral artery cerebral blood flow velocity, and PaCO2 during the first week of life. Models using multivariate generalized linear regression and purposeful selection were used to determine associations with severe IVH. Results Severe IVH (grades 3-4) was observed in 14.6% of the infants. Irrespective of the model used, Apgar score at 5 minutes and DCM were significantly associated with severe IVH. A clinically relevant 5-mm Hg increase in DCM was associated with a 1.83- to 1.89-fold increased odds of developing severe IVH. Conclusion Elevated DCM was associated with severe IVH, consistent with previous animal data showing that IVH is associated with hyperperfusion. Measurement of DCM may be more useful than blood pressure in defining cerebral perfusion in premature infants. |
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| AbstractList | Objective To determine whether the diastolic closing margin (DCM), defined as diastolic blood pressure minus critical closing pressure, is associated with the development of early severe intraventricular hemorrhage (IVH). Study design A reanalysis of prospectively collected data was conducted. Premature infants (gestational age 23-31 weeks) receiving mechanical ventilation (n = 185) had ∼1-hour continuous recordings of umbilical arterial blood pressure, middle cerebral artery cerebral blood flow velocity, and PaCO2 during the first week of life. Models using multivariate generalized linear regression and purposeful selection were used to determine associations with severe IVH. Results Severe IVH (grades 3-4) was observed in 14.6% of the infants. Irrespective of the model used, Apgar score at 5 minutes and DCM were significantly associated with severe IVH. A clinically relevant 5-mm Hg increase in DCM was associated with a 1.83- to 1.89-fold increased odds of developing severe IVH. Conclusion Elevated DCM was associated with severe IVH, consistent with previous animal data showing that IVH is associated with hyperperfusion. Measurement of DCM may be more useful than blood pressure in defining cerebral perfusion in premature infants. To determine whether the diastolic closing margin (DCM), defined as diastolic blood pressure minus critical closing pressure, is associated with the development of early severe intraventricular hemorrhage (IVH). A reanalysis of prospectively collected data was conducted. Premature infants (gestational age 23-31 weeks) receiving mechanical ventilation (n = 185) had ∼1-hour continuous recordings of umbilical arterial blood pressure, middle cerebral artery cerebral blood flow velocity, and PaCO2 during the first week of life. Models using multivariate generalized linear regression and purposeful selection were used to determine associations with severe IVH. Severe IVH (grades 3-4) was observed in 14.6% of the infants. Irrespective of the model used, Apgar score at 5 minutes and DCM were significantly associated with severe IVH. A clinically relevant 5-mm Hg increase in DCM was associated with a 1.83- to 1.89-fold increased odds of developing severe IVH. Elevated DCM was associated with severe IVH, consistent with previous animal data showing that IVH is associated with hyperperfusion. Measurement of DCM may be more useful than blood pressure in defining cerebral perfusion in premature infants. OBJECTIVETo determine whether the diastolic closing margin (DCM), defined as diastolic blood pressure minus critical closing pressure, is associated with the development of early severe intraventricular hemorrhage (IVH).STUDY DESIGNA reanalysis of prospectively collected data was conducted. Premature infants (gestational age 23-31 weeks) receiving mechanical ventilation (n = 185) had ∼1-hour continuous recordings of umbilical arterial blood pressure, middle cerebral artery cerebral blood flow velocity, and PaCO2 during the first week of life. Models using multivariate generalized linear regression and purposeful selection were used to determine associations with severe IVH.RESULTSSevere IVH (grades 3-4) was observed in 14.6% of the infants. Irrespective of the model used, Apgar score at 5 minutes and DCM were significantly associated with severe IVH. A clinically relevant 5-mm Hg increase in DCM was associated with a 1.83- to 1.89-fold increased odds of developing severe IVH.CONCLUSIONElevated DCM was associated with severe IVH, consistent with previous animal data showing that IVH is associated with hyperperfusion. Measurement of DCM may be more useful than blood pressure in defining cerebral perfusion in premature infants. |
| Author | Smielewski, Peter, PhD Kaiser, Jeffrey R., MD, MA Kibler, Kathleen K., CCP Rios, Danielle R., MD Czosnyka, Marek, PhD Rusin, Craig G., PhD Easley, R. Blaine, MD Brady, Ken M., MD Gauss, C. Heath, MS Andropoulos, Dean B., MD Williams, D. Keith, PhD, MPH Rhee, Christopher J., MD Varsos, Georgios V., PhD |
| AuthorAffiliation | c Departments of Anesthesiology, Critical Care Medicine, and Pediatrics, Texas Children’s Hospital/Baylor College of Medicine, Houston, TX, USA f Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA a Department of Pediatrics, Section of Neonatology, Texas Children’s Hospital/Baylor College of Medicine, Houston, TX, USA d Department of Academic Neurosurgery, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK e Department of Cardiology, Texas Children’s Hospital/Baylor College of Medicine, Houston, TX, USA b Department of Obstetrics and Gynecology, Texas Children’s Hospital/Baylor College of Medicine, Houston, TX, USA |
| AuthorAffiliation_xml | – name: b Department of Obstetrics and Gynecology, Texas Children’s Hospital/Baylor College of Medicine, Houston, TX, USA – name: c Departments of Anesthesiology, Critical Care Medicine, and Pediatrics, Texas Children’s Hospital/Baylor College of Medicine, Houston, TX, USA – name: e Department of Cardiology, Texas Children’s Hospital/Baylor College of Medicine, Houston, TX, USA – name: a Department of Pediatrics, Section of Neonatology, Texas Children’s Hospital/Baylor College of Medicine, Houston, TX, USA – name: f Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA – name: d Department of Academic Neurosurgery, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK |
| Author_xml | – sequence: 1 fullname: Rhee, Christopher J., MD – sequence: 2 fullname: Kaiser, Jeffrey R., MD, MA – sequence: 3 fullname: Rios, Danielle R., MD – sequence: 4 fullname: Kibler, Kathleen K., CCP – sequence: 5 fullname: Easley, R. Blaine, MD – sequence: 6 fullname: Andropoulos, Dean B., MD – sequence: 7 fullname: Czosnyka, Marek, PhD – sequence: 8 fullname: Smielewski, Peter, PhD – sequence: 9 fullname: Varsos, Georgios V., PhD – sequence: 10 fullname: Rusin, Craig G., PhD – sequence: 11 fullname: Gauss, C. Heath, MS – sequence: 12 fullname: Williams, D. Keith, PhD, MPH – sequence: 13 fullname: Brady, Ken M., MD |
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| Keywords | CBF NICU Intraventricular hemorrhage Diastolic closing margin Cerebral blood flow velocity Estimated gestational age ABP DCM CBFV arterial blood pressure critical closing pressure Neonatal intensive care unit cerebral blood flow IVH CrCP EGA |
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| Snippet | Objective To determine whether the diastolic closing margin (DCM), defined as diastolic blood pressure minus critical closing pressure, is associated with the... To determine whether the diastolic closing margin (DCM), defined as diastolic blood pressure minus critical closing pressure, is associated with the... OBJECTIVETo determine whether the diastolic closing margin (DCM), defined as diastolic blood pressure minus critical closing pressure, is associated with the... |
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| SubjectTerms | arterial blood pressure Blood Flow Velocity - physiology Blood Pressure - physiology cerebral blood flow Cerebral Hemorrhage - etiology Cerebral Hemorrhage - physiopathology Cohort Studies critical closing pressure Diastole Female Humans Infant, Newborn Infant, Premature Infant, Premature, Diseases - etiology Infant, Premature, Diseases - physiopathology Male Middle Cerebral Artery - physiology Pediatrics Respiration, Artificial Umbilical Arteries - physiology |
| Title | Elevated Diastolic Closing Margin Is Associated with Intraventricular Hemorrhage in Premature Infants |
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