Continuous Monitoring for Cerebral Pressure-Passivity in Premature Infants

早产儿脑压力被动性的连续监测

• 批准号: 7293428
• 负责人: ADRE Jacques DU PLESSIS
• 金额: $ 21.13万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-10 至 2009-09-09
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7293428
• 关键词: Age; Blood Pressure; Brain; Brain Injuries; Carbon Dioxide; Cephalic; Cerebrum; Characteristics; Clinical; Clinical Research; Condition; Critical Illness; Development; Devices; Diagnosis; Disease; Drug Formulations; Hemoglobin; Homeostasis; Hour; Hypotension; Hypoxia; Infant; Injury; Lead; Life; Measurement; Measures; Mediating; Monitor; Morbidity - disease rate; Nature; Near-Infrared Spectroscopy; Pattern; Premature Infant; Prematurity of fetus; Public Health; Research; Risk; Role; Signal Transduction; System; Techniques; Time; Urination; Validation; Vulnerable Populations; Work; age related; base; cerebrovascular; disability; hemodynamics; indexing; infrared spectroscopy; injury prevention; intraventricular hemorrhage; novel; postnatal; pressure; prevent; technique development

DESCRIPTION (provided by applicant): Brain injury in the preterm infant is a problem of enormous magnitude and is mediated largely by cerebrovascular mechanisms emanating from disturbed vasoregulation in the immature brain. Pressure passivity is a major manifestation of disturbed cerebral vasoregulation and is pivotal in both hypoxic-ischemic (HI) and hemorrhagic brain injury in premature infants. Cerebral pressure passivity develops when systemic blood pressure (BP) is unstable and cerebral pressure autoregulation is impaired. We have demonstrated that hypotension, as well as fluctuations in blood pressure and cerebral pressure passivity are common in sick premature infants. The lack of an integrated bedside technique that continuously monitors the dynamic relationship between these signals to identify cerebral pressure-passivity has impeded the formulation of rational strategies for BP management aimed at preventing brain injury in the preterm infant. We have developed such a system that measures continuous cerebral near infrared spectroscopy (NIRS) and BP changes to identify periods of cerebral pressure passivity at the bedside of sick infants. We measure the coherence (using transfer function analysis) between changes in systemic BP and the cerebral NIRS hemoglobin difference (HbD) signal; we then derive a pressure-passive index (PPI) in order to quantify pressure passivity over time. In the research proposed here, we aim to begin validating the ability of cerebral pressure passivity measured by our technique to identify imminent germinal matrix-intraventricular hemorrhage (GM-IVH) detected by 4-hourly 'scout' US studies. In addition, we will seek to define characteristics of systemic BP and CO2 levels that predispose to pressure passivity. If validated, this approach will have enormous benefit for the advance of biomedical and clinical research and most importantly will lead to the eventual development of rational brain-oriented hemodynamic management that prevents the devastating brain injuries of prematurity. As such the work proposed here is squarely directed at maximizing opportunities for this extremely vulnerable population to fulfill their potential for a healthy and productive life unhampered by disease or disability. Cerebrovascular injury in premature infants causes devastating longterm neurdevelopmental morbidity and is a public health issue of enormous magnitude. Prevention of this injury has been impeded by an incomplete understanding of the hemodynamic insults involved and the inability to identify these insults before injury becomes irreversible. We have developed a technique that aims to fill both these voids and now seek support for its validation in sick premature infants.

描述（由申请人提供）：早产婴儿的脑损伤是一个巨大的问题，主要是由由于未成熟大脑中的血管调节而发出的脑血管机制介导的。压力被动性是脑部血管调节障碍的主要表现，并且在早产儿中低氧 - 缺血（HI）和出血性脑损伤都是关键的。当全身血压（BP）不稳定并且大脑压力自动调节受损时，脑压值会出现。我们已经证明，在病态的早产儿中，低血压以及血压和脑压的波动很常见。缺乏一种综合的床边技术，该技术不断监视这些信号之间的动态关系以识别脑压缩性，这阻碍了为BP管理的理性策略制定，旨在防止早产儿的脑损伤。我们已经开发了这样一个系统，该系统测量了近红外光谱（NIR）和BP变化的连续大脑，以识别病假婴儿床边的大脑压力被动时期。我们在系统性BP和脑NIRS血红蛋白差异（HBD）信号之间的变化之间测量（使用传递函数分析）；然后，我们得出压力指数（PPI），以量化随时间的压力被动性。在此处提出的研究中，我们旨在开始验证通过我们的技术测量的脑压子被动性的能力，以鉴定由4小时“侦察”美国研究检测到的即将发生的生发基质内部脑出血（GM-IVH）。此外，我们将寻求定义易于压力被动性的全身性BP和CO2水平的特征。如果得到验证，这种方法将对生物医学和临床研究的发展具有巨大的好处，最重要的是，最终会导致最终发展理性的面向脑动力学的血液动力学管理，从而阻止了毁灭性的早产脑损伤。因此，这里提出的工作是最大程度地旨在使这个极其脆弱的人群最大限度地发挥机会，以实现其健康和生产力的潜力，并受到疾病或残疾的影响。早产婴儿的脑血管损伤会导致毁灭性的长期神经发病率，并且是一个巨大的公共卫生问题。对所涉及的血液动力学损伤的不完全理解以及在伤害变得不可逆转的情况下无法识别这些损伤的情况，这阻碍了这种伤害。我们开发了一种旨在填补这两个空白的技术，现在寻求对病态早产婴儿的验证的支持。