Therefore, continuous monitoring of CBF and its autoregulation in ELGA infants may guide practices to reduce the risk of brain injury, including GM/IVH, especially during the period of physiological instability in the first 72 h of life.ĭiffuse correlation spectroscopy (DCS) is a non-invasive, optical CBF monitoring technique that can be utilized at the bedside for continuous monitoring. These episodes are related to an impaired cerebral autoregulation (CAR), resulting in a direct injury to the GM, which has a fragile, dense vasculature that remains underdeveloped until 33 weeks of gestation 2, 4, 6, 7, 8, 9. One proposed etiology of GM/IVH is poor regulation of cerebral blood flow (CBF) contributing to frequent episodes of: (1) cerebral hypo-perfusion followed by hyper-perfusion and/or (2) passive CBF changes to systemic influences, such as blood pressure (BP). Moreover, 90% of the GM/IVH cases are diagnosed within the first 72 h after the birth, highlighting the importance of close monitoring during this critical period 2, 5. Of these, approximately 15,000 (25%) are diagnosed with a germinal matrix/intraventricular hemorrhage (GM/IVH) that often results in adverse neurodevelopmental outcomes or death 2, 3, 4. The proposed method is potentially useful at the bedside for the prompt assessment of cerebral autoregulation and early identification of infants vulnerable to GM/IVH.Īpproximately 1–2% of all births worldwide occur at the extremes of immaturity (extremely low gestational age, ELGA, < 29 weeks GA), resulting in approximately 60,000 affected newborn infants in the United States each year 1. In nineteen ELGA infants (with 9 cases of GM/IVH) monitored for 6–24 h between days 2–5 of life, we found a strong correlation between CBF and SBF in severe IVH (Grade III or IV) and IVH diagnosed within 72 h of life, while CBF variability alone was not associated with IVH. We report the feasibility of the continuous monitoring of CBF, including measures of autoregulation, via diffuse correlation spectroscopy (DCS) in ELGA infants using CBF variability and correlation with scalp blood flow (SBF, served as a surrogate measure of systemic perturbations).
Continuous monitoring of CBF can guide interventions to minimize the risk of brain injury, but there are no clinically standard techniques or tools for its measurement. In premature infants with an extremely low gestational age (ELGA, < 29 weeks GA), dysregulated changes in cerebral blood flow (CBF) are among the major pathogenic factors leading to germinal matrix/intraventricular hemorrhage (GM/IVH).