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The effect of intubation on CBFV in preterm infants
ABSTRACTS
S58
clonidine administration. The FFT analysis of the v, recordings at the onset of oscillations, revealed a sign&ant increase in the total power (area of the spectrum) and decrease in the median frequency. Conclusions: Clonidine modifted cerebral haemodynamics in both groups of patients. However, this effect was slightly delayed in hypertensive patients and was associated with an increase in signs of sympathetic activity in cerebral vasculature. Sympathetic pathway is hypothesized to act mainly on the conductance vessels.
The inthence
of mode of ddiveq
on CBF’Vof
term i&ants
OS. Ipsiroglu’, H. Rosegger’. ‘Department of NICU/ Pediatrics,UniversityHospitalof Viinna; ‘Depament of Obstetricsand Gynuecology,Universityof Graz, Austria
Aim of this study was to investigate cerebral blood flow velocities (CBFV) in term infants horn breech presentation according to mode of delivery. Patients and methods: Maximum and mean CBFV were measured with a 5.5 MHz short focused colour flow transducer (Hewlett Packard Sonos 1000) in anterior cerebral arteries immediately after delivery within the first 4 min and at 20-30 min of life after cardiopulmonary stabilisation. Patients: Vaginal delivery: n = 10, ga: 39.1 f 1.5, bw: 3010 f 440; art. cord-pH 7.20 f 0.09. Abdominal delivery: n = 9, ga: 39.7 f 1.6, bw: 3370 & 820; art. cord-pH 7.29 f 0.04. Results: In 8/10 and 8/9 infants CBFV decreased by almost 60% of baseline values. The remaining infants showed an increase of CBFV. Two infants delivered abdominally had very high CBFV immediately after birth followed by a rapid decline. There was no correlation between these high CBFV and arterial-cord and capillary-blood gas-analysis (pH: 7.28/7.30; pC0,: 35/45 mmI-Ig), but in both cases delivery of the head was mechanically difficult. Discussion: Our Iindings show that in term infants from breech presentation with non-acidotic cord pH, significant alterations of CBFV may occur independently of the mode of delivery. Mechanical factors might explain these marked changes. Supported by Hewlett Packard Vienna and Pediatric Research Foundation of the Department of Pediatrics, University of Graz.
I‘lo9
The effect of &h&ion infants
on CBFV in pretem
O.S. Ipsiroglu’, H. Rosegger2.‘Depariments of NlCU/ Pediatrics,UniversityHospitalof Vkma; ‘Department of Obstetricsand Gynaecology,Universiq of Graz, Austria Background Preterm neonates with rapid alterations of cerebral blood flow velocities (CBFV) are at higher risk for intracranial hemorrhage. Few data have yet been published on the effect of intubation on CBFV immediately after birth during resuscitation procedures. Patients and methods: We observed 15 premature infants delivered abdominally (n = 15; GA: 29.3 f 1.8, bw: 1140 f 210, arterial cord-pH: 7.29 f 0.04; ApgarScore at 1’/5’: 8 f 2 /9 f 1) Maximum and mean velocities in anterior cerebral arteries were studied with Doppler sonography immediately after delivery and during resuscitation procedures (5.5 MHz short focused colour flow transducer, Hewlett Packard Sonos 1000). Almost 50% of measurements started within the first minute of life and all were continued until stabilisation of the neonates and transport to NICU (3060 min after delivery). Results: Major alterations in CBFV were observed during intubation: alterations were classified in low (< 30%, n = 4), medium (30-80%, n = 7) and high (> 80%, n = 5). Low and medium alterations were also observed during putting an i.v. line, endotracheal or even pharyngeal suctioning. The highest alterations were observed in a case where insertion of endotracheal tube made technical problems. Alterations were almost 200%. In this infant CBFV turned to baseline values only after 15 min. Conclusion: Our results suggest that major alterations of CBFV are caused by resuscitation procedures. These observations stress the importance of minimal handling and exact monitoring of resuscitation procedures for quality control and evidential value. Supported by Hewlett Packard Vienna and Pediatric Research Foundation of the Department of Pediatrics, University of Graz, Austria
I
“lo
Effects of intubation on CBF’Vin infants with compromised cerebrovascular autoregulation
O.S. Ipsiroglu’, S. Kuhle’, J. Kohler’, B. Meger’, C.
S58
clonidine administration. The FFT analysis of the v, recordings at the onset of oscillations, revealed a sign&ant increase in the total power (area of the spectrum) and decrease in the median frequency. Conclusions: Clonidine modifted cerebral haemodynamics in both groups of patients. However, this effect was slightly delayed in hypertensive patients and was associated with an increase in signs of sympathetic activity in cerebral vasculature. Sympathetic pathway is hypothesized to act mainly on the conductance vessels.
The inthence
of mode of ddiveq
on CBF’Vof
term i&ants
OS. Ipsiroglu’, H. Rosegger’. ‘Department of NICU/ Pediatrics,UniversityHospitalof Viinna; ‘Depament of Obstetricsand Gynuecology,Universityof Graz, Austria
Aim of this study was to investigate cerebral blood flow velocities (CBFV) in term infants horn breech presentation according to mode of delivery. Patients and methods: Maximum and mean CBFV were measured with a 5.5 MHz short focused colour flow transducer (Hewlett Packard Sonos 1000) in anterior cerebral arteries immediately after delivery within the first 4 min and at 20-30 min of life after cardiopulmonary stabilisation. Patients: Vaginal delivery: n = 10, ga: 39.1 f 1.5, bw: 3010 f 440; art. cord-pH 7.20 f 0.09. Abdominal delivery: n = 9, ga: 39.7 f 1.6, bw: 3370 & 820; art. cord-pH 7.29 f 0.04. Results: In 8/10 and 8/9 infants CBFV decreased by almost 60% of baseline values. The remaining infants showed an increase of CBFV. Two infants delivered abdominally had very high CBFV immediately after birth followed by a rapid decline. There was no correlation between these high CBFV and arterial-cord and capillary-blood gas-analysis (pH: 7.28/7.30; pC0,: 35/45 mmI-Ig), but in both cases delivery of the head was mechanically difficult. Discussion: Our Iindings show that in term infants from breech presentation with non-acidotic cord pH, significant alterations of CBFV may occur independently of the mode of delivery. Mechanical factors might explain these marked changes. Supported by Hewlett Packard Vienna and Pediatric Research Foundation of the Department of Pediatrics, University of Graz.
I‘lo9
The effect of &h&ion infants
on CBFV in pretem
O.S. Ipsiroglu’, H. Rosegger2.‘Depariments of NlCU/ Pediatrics,UniversityHospitalof Vkma; ‘Department of Obstetricsand Gynaecology,Universiq of Graz, Austria Background Preterm neonates with rapid alterations of cerebral blood flow velocities (CBFV) are at higher risk for intracranial hemorrhage. Few data have yet been published on the effect of intubation on CBFV immediately after birth during resuscitation procedures. Patients and methods: We observed 15 premature infants delivered abdominally (n = 15; GA: 29.3 f 1.8, bw: 1140 f 210, arterial cord-pH: 7.29 f 0.04; ApgarScore at 1’/5’: 8 f 2 /9 f 1) Maximum and mean velocities in anterior cerebral arteries were studied with Doppler sonography immediately after delivery and during resuscitation procedures (5.5 MHz short focused colour flow transducer, Hewlett Packard Sonos 1000). Almost 50% of measurements started within the first minute of life and all were continued until stabilisation of the neonates and transport to NICU (3060 min after delivery). Results: Major alterations in CBFV were observed during intubation: alterations were classified in low (< 30%, n = 4), medium (30-80%, n = 7) and high (> 80%, n = 5). Low and medium alterations were also observed during putting an i.v. line, endotracheal or even pharyngeal suctioning. The highest alterations were observed in a case where insertion of endotracheal tube made technical problems. Alterations were almost 200%. In this infant CBFV turned to baseline values only after 15 min. Conclusion: Our results suggest that major alterations of CBFV are caused by resuscitation procedures. These observations stress the importance of minimal handling and exact monitoring of resuscitation procedures for quality control and evidential value. Supported by Hewlett Packard Vienna and Pediatric Research Foundation of the Department of Pediatrics, University of Graz, Austria
I
“lo
Effects of intubation on CBF’Vin infants with compromised cerebrovascular autoregulation
O.S. Ipsiroglu’, S. Kuhle’, J. Kohler’, B. Meger’, C.