Cerebral blood flow in the neonate

Paediatr Anaesth. 2014 Jan;24(1):22-9. doi: 10.1111/pan.12307. Epub 2013 Nov 15.

Abstract

Ensuring adequate oxygenation of the developing brain is the cornerstone of neonatal critical care. Despite decades of clinical research dedicated to this issue of paramount importance, our knowledge and understanding regarding the physiology and pathophysiology of neonatal cerebral blood flow are still rudimentary. This review primarily focuses on currently available human clinical and experimental data on cerebral blood flow and autoregulation in the preterm and term infant. Limitations of systemic blood pressure values as surrogates for monitoring adequate cerebral oxygen delivery are discussed. Particular emphasis is placed on the high interindividual variability in cerebral blood flow values, vasoreactivity, and autoregulatory thresholds making the applications of normative values highly questionable. Technical and ethical difficulties to conduct such trials leave us with a near complete lack of knowledge on how pharmacological and surgical interventions impact on cerebral autoregulation. The ensemble of these works argues for the necessity of highly individualized care by taking advantage of continuous bedside monitoring of cerebral circulation. They also point to the urgent need for further studies addressing the exciting but difficult issue of cerebral blood flow autoregulation in the neonate.

Keywords: autoregulation; brain; cerebral blood flow; development; hypotension; neonate.

Publication types

  • Review

MeSH terms

  • Blood Pressure / physiology
  • Cerebrovascular Circulation / physiology*
  • Homeostasis / physiology
  • Humans
  • Hypotension / physiopathology
  • Infant, Newborn / physiology*
  • Reference Values