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Schwaberger, B.
Behaviour of cerebral blood volume (CBV) during neonatal transition in preterm infants with and without respiratory support
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Graz Medical University; 2017. pp. [OPEN ACCESS]


Authors Med Uni Graz:
Einspieler Christa
Pichler Gerhard
Urlesberger Berndt

The transition from fetal to neonatal life is dependent upon complex physiological changes in the respiratory and cardiovascular system. Major transitional changes at birth also affect the brain as the most vulnerable organ. Because of its prognostic importance, there is a special scientific interest in cerebral perfusion immediately after birth. Different methods to assess cerebral perfusion during postnatal transition have been introduced including near-infrared spectroscopy (NIRS) providing information on changes in cerebral blood volume (CBV). Transitional changes in CBV had not been investigated until we published the data of the CBV study in which we evaluated CBV during immediate postnatal transition in healthy term infants plotting the physiological behaviour of CBV after birth by using NIRS. In this study we demonstrated a decrease in CBV in healthy term infants during immediate postnatal transition and hypothesized that this was due to changes within the autoregulatory capacity of cerebral vessels in reaction to increasing pO2 and decreasing pCO2 levels. Recently, our research group showed that requirement for respiratory support (RS) after birth in preterm infants is associated with lower cerebral oxygenation compared to infants undergoing normal transition. Therefore, the CBV_RESUP study (Cerebral Blood Volume in infants receiving REspiratory SUPport during neonatal transition study) was designed to investigate transitional changes in CBV in term and preterm infants with and without requirement for RS to estimate the potential influence of RS on the postnatal CBV behaviour. We observed a significant decrease of CBV in infants undergoing normal transition and in infants receiving RS. Interestingly, changes in CBV were smaller in the first seven minutes in neonates with RS. This study did not yet determine, whether RS itself or the condition of the infant leading to requirement for RS is responsible for the observed differences in CBV behaviour compared to healthy newborn infants. In summary, the present data are the first describing CBV behaviour during immediate transition in healthy newborn infants and in newborn infants with requirement for RS. Our results are of particularly great interest, since hemodynamic disturbances resulting in changes in cerebral perfusion are discussed to be an important pathway to ventilation-induced brain injury occurring as early as ventilation is initiated in the delivery room.

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