Cerebral perfusion pressure monitoring in premature newborns.

Cerebral perfusion pressure (CPP), believed to be a major determinant of neurologic outcome, was monitored at the bedside of high-risk premature newborns during the first few days of life. Intraventricular hemorrhage was presumed to have occurred in only one of the seven infants and was associated with ventriculomegaly and early death. The other infants had good neurologic outcomes at age 18 months despite low mean CPPs (less than 30 mm Hg). These low CPPs were determined to be dependent on mean arterial blood pressures and not on intracranial pressures which were low in all infants (and even lower in more premature infants with apnea). Methylxanthine treatment of apnea of prematurity did not apparently change CPP, despite hypothetical effects on cerebral and peripheral vascular tone. Although fairly low CPP can be associated with good neurologic outcome, it may not be useful in monitoring newborn infants.