Effect of tilting on cerebral haemodynamics in preterm infants with periventricular leucencephalomalacia.

AIM: Measurement of cerebral haemodynamics to detect impaired cerebral blood flow and impaired cerebral autoregulation might make prevention of brain lesions and especially periventricular leucencephalomalacia (PVL) achievable.

METHODS

Changes in cerebral blood volume (CBV) and the cerebral haemoglobin oxygenation index (cHbD) following tilting up and down in 10 preterm infants with PVL and 25 preterm infants without PVL, measured by near infrared spectroscopy (NIRS), were analysed. Tilting manoeuvres were recorded with a polysomnographic system in combination with NIRS. CBV and cHbD of the baseline phase (1 min before tilting) were compared with data from the post-tilting phase (1 min after tilting).

RESULTS

Changes in CBV and cHbD after tilting were significantly pronounced in infants with PVL compared with infants without PVL. CBV decreased in infants with PVL, by -0.099 +/- 0.081 ml 100 g(-1) brain (mean +/- SD) after tilting up, and increased by 0.106 +/- 0.104 ml 100 g(-1) brain after tilting down. CBV decreased in infants without PVL, by -0.041 +/- 0.068 ml 100 g(-1) brain after tilting up, and increased by 0.020 +/- 0.096 ml 100 g(-1) brain after tilting down. cHbD showed similar changes after tilting.

CONCLUSION

Changes in CBV and cHbD after tilting were pronounced in preterm infants with PVL and this may indicate reduced cerebral autoregulatory capacity.