Fluctuations in internal cerebral vein and central side veins of preterm infants.

BACKGROUND: Studies on the acute management of extremely low birthweight (ELBW) infants reveal a high incidence of intraventricular hemorrhage (IVH) in infants with high-grade internal cerebral vein perfusion waveform fluctuations. In this prospective observational study we investigated the Doppler perfusion waveform fluctuations in the great cerebral vein, straight sinus, and internal cerebral veins of ELBW infants. METHODS: We evaluated perfusion waveforms after birth every 12 h until 120 h in 73 ELBW infants (<1,000 g) at our hospital. Fluctuations were categorized into four patterns of increasing magnitude, Grades 0-3. RESULTS: The maximum grades of perfusion waveform fluctuations of the internal cerebral veins were 0, 1, 2, and 3 detected in 12, 38, 13, and 10 infants, respectively; those of the great cerebral vein were 0, 1, 2, and 3 detected in 5, 17, 20, and 31 infants, respectively; and those of the straight sinus were 0, 1, 2, and 3 detected in 1, 5, 17, and 50 infants, respectively. Only one of 803 simultaneous measurements of the Doppler perfusion waveforms showed stronger fluctuations of the peripheral vein than those of the central side veins. Intraventricular hemorrhage was associated with high-grade fluctuations in the internal cerebral veins but not in the great cerebral vein or straight sinus. CONCLUSIONS: Most infants had high-grade fluctuations in the great cerebral vein and straight sinus, with lower grade fluctuations in the internal cerebral vein, but IVH was not associated with those markers. Intraventricular hemorrhage was correlated with high-grade fluctuations only in the internal cerebral veins.

Hemodynamics of infants with strong fluctuations of internal cerebral vein.

BACKGROUND: There is a high incidence of intraventricular hemorrhage in extremely low-birthweight (ELBW) infants of low gestational age with high-grade fluctuations in the perfusion waveform of the internal cerebral vein. This study investigated changes in the hemodynamic status of ELBW infants during initial strong fluctuations in the perfusion waveform of the internal cerebral vein. METHODS: We evaluated the perfusion waveform of the internal cerebral vein in 192 ELBW infants from birth, every 8 h for a total of 120 h. Sixty-seven infants had high-grade fluctuations. On the basis of the presence of patent ductus arteriosus (PDA), patients were subdivided into PDA(-) (n = 32) and PDA(+) (n = 35) groups. RESULTS: During the first high-grade fluctuation, the PDA(-) group had significant increases in systolic, diastolic, and mean blood pressure (P < 0.001 for all). The PDA(+) group did not have significant changes in blood pressure but did have significant increases in the number of interruptions or regurgitations of diastolic renal arterial blood flow (P = 0.04) and end-diastolic left pulmonary arterial flow velocity (P < 0.001), indicating increased left-to-right shunt. CONCLUSIONS: Blood pressure elevation may underlie fluctuations in the perfusion waveform of the internal cerebral vein and lead to the first high-grade increases during acute management of ELBW infants. When no elevation in blood pressure occurred, hemodynamically significant PDA was considered a potential underlying factor.