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）：早产儿的脑损伤是一个非常严重的问题，并且主要是由未成熟大脑中血管调节紊乱引起的脑血管机制介导的。压力被动性是脑血管调节紊乱的主要表现，并且在早产儿缺氧缺血性（HI）和出血性脑损伤中至关重要。当全身血压（BP）不稳定且脑压自动调节受损时，就会出现脑压被动性。我们已经证明，低血压以及血压波动和脑压被动性在患病的早产儿中很常见。由于缺乏连续监测这些信号之间的动态关系以识别脑压力被动性的综合床边技术，阻碍了旨在预防早产儿脑损伤的合理血压管理策略的制定。我们开发了这样一个系统，可以测量连续脑近红外光谱 (NIRS) 和血压变化，以识别病婴床边的脑压被动期。我们测量全身血压变化和脑 NIRS 血红蛋白差值 (HbD) 信号之间的一致性（使用传递函数分析）；然后，我们得出压力被动指数（PPI），以量化随时间变化的压力被动性。在此提出的研究中，我们的目标是开始验证通过我们的技术测量的脑压被动性的能力，以识别由美国每 4 小时“侦察”研究检测到的即将发生的生发基质脑室内出血 (GM-IVH)。此外，我们将寻求定义容易产生压力被动的全身血压和二氧化碳水平的特征。如果得到验证，这种方法将为生物医学和临床研究的进步带来巨大的好处，最重要的是，将导致最终开发出合理的以大脑为导向的血流动力学管理，以防止早产儿造成的毁灭性脑损伤。因此，这里提出的工作直接针对为这一极其脆弱的人群提供最大限度的机会，以发挥他们的潜力，过上不受疾病或残疾阻碍的健康和富有成效的生活。早产儿的脑血管损伤会导致毁灭性的长期神经发育发病率，是一个巨大的公共卫生问题。由于对所涉及的血流动力学损伤的不完全理解以及无法在损伤变得不可逆转之前识别这些损伤，阻碍了这种损伤的预防。我们开发了一种技术，旨在填补这些空白，现在正在寻求支持以支持其在患病早产儿中的验证。