Noninvasive optical measures of CBV, StO(2), CBF index, and rCMRO(2) in human premature neonates' brains in the first six weeks of life

Abstract

With the causes of perinatal brain injuries still unclear and the probable role of hemodynamic instability in their etiology, bedside monitoring of neonatal cerebral hemodynamics with standard values as a function of age are needed. In this study, we combined quantitative frequency domain near infrared spectroscopy (FD-NIRS) measures of cerebral tissue oxygenation (StO(2)) and cerebral blood volume (CBV) with diffusion correlation spectroscopy (DCS) measures of a cerebral blood flow index (CBF(ix)) to test the validity of the CBV-CBF relationship in premature neonates and to estimate cerebral metabolic rate of oxygen (rCMRO(2)) with or without the CBF(ix) measurement. We measured 11 premature neonates (28-34 weeks gestational age) without known neurological issues, once a week from one to six weeks of age. In nine patients, cerebral blood velocities from the middle cerebral artery were collected by transcranial Doppler (TCD) and compared with DCS values. Results show a steady decrease in StO(2) during the first six weeks of life while CBV remains stable, and a steady increase in CBF(ix). rCMRO(2) estimated from FD-NIRS remains constant but shows wide interindividual variability. rCMRO(2) calculated from FD-NIRS and DCS combined increased by 40% during the first six weeks of life with reduced interindividual variability. TCD and DCS values are positively correlated. In conclusion, FD-NIRS combined with DCS offers a safe and quantitative bedside method to assess CBV, StO(2), CBF, and rCMRO(2) in the premature brain, facilitating individual follow-up and comparison among patients. A stable CBV-CBF relationship may not be valid for premature neonates.

2009 Wiley-Liss, Inc.

Figures

Figure 1

A: Picture of a subject during a measurement. B: Locations of recording on the subject's head. C: Schema of the probe.

Figure 2

Individual traces as a function of age. A: HbT. B: StO2. C: CBV. D: CBFix. E: rCMRO2 estimated from FD‐NIRS only. F: rCMRO2 calculated by combining FD‐NIRS and DCS. Dotted lines are subjects born after 32 wGA, solid lines for subjects born before 32 wGA.

Figure 3

Averages ±95% confidence intervals as a function of age. A: HbT. B: StO2. C: CBV. D: CBFix. E: rCMRO2 estimated from FD‐NIRS only. F: rCMRO2 calculated by combining FD‐NIRS and DCS. Bold lines are linear regressions; R2 and P‐value of the regressions are in the bottom right corner of each graph.

Figure 4

Scatterplot of the average of PS and ED values (TCD) versus (DCS). The bold line is the linear regression; R2 and P‐value of the regression is in the bottom right corner.