Paper of the week: Improving risk assessment in preterm babies
Zhang, Y., Chan, G. S. H., Tracy, M. B., Lee, Q. Y., Hinder, M., Savkin, A. V., & Lovell, N. H. (2011). Spectral analysis of systemic and cerebral cardiovascular variabilities in preterm infants: relationship with clinical risk index for babies (CRIB). Physiological Measurement, 32(12), 1913-28.
Preterm infants with birth weights less than 1500 grams are at increased risk of long-term neurological damage due to high susceptibility to brain hemorrhage. In the healthy brain cerebral blood flow is tightly regulated, whereas in preterm infants there is a dependence on passive pressure from arterial circulation. Hence increases in systemic blood pressure pose a significant risk for cerebrovascular injury.
Internationally, the Clinical Risk Index for Babies (CRIB) is widely used to assess the mortality risk of very preterm babies; this is easily computed using gestational age, weight, temperature, blood gases and blood base buffering. The goal of the present study was to establish whether parameters derived from spectral analysis of blood pressure variability, heart rate variability, and cerebral oxygenation (non-invasive near-infrared spectroscopy) might provide additional prognostic value.
Seventeen preterm infants with mean gestational age of 26 ± 2 weeks and birth weight of 1024 ± 351 grams were recruited for the study. Significant correlations were found between their CRIB scores and spectral parameters relating to baroreflex and cerebral blood flow regulation. For instance, the correlation between CRIB and the transfer function of mean arterial pressure and deoxygenated cerebral blood revealed a positive relationship (p<0.01). This reflected that higher CRIB scores are likely to be associated with greater systemic pressure, leading to increased blood perfusion in the brain.
On the basis of their findings, the authors conclude that spectral analysis of baroreflex sensitivity and cerebral blood flow warrants further investigation for use in risk assessment in preterm infants.
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06 January 2012
