Surfactant Therapy and Intracranial Hemorrhage: Review of the Literature and Results of New Analyses

PEDIATRICS ◽  
1993 ◽  
Vol 92 (6) ◽  
pp. 775-786
Author(s):  
J. Harry Gunkel ◽  
Phillip L.C. Banks
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Birth Weight ◽  
Intracranial Hemorrhage ◽  
Incidence Rates ◽  
Surfactant Therapy ◽  
Controlled Study ◽  
Hemodynamic Changes ◽  
Increased Risk ◽  
Risk Of Hemorrhage

Background and objective. Surfactant replacement is a powerful therapy for newborns with respiratory distress syndrome, but limited observations suggest that alterations of cerebral blood flow can accompany the use of several available surfactants. An early European multicenter controlled study with beractant demonstrated an increased rate of intracranial hemorrhage in treated patients. Nine additional controlled studies were subsequently performed and included follow-up evaluations through 2 years adjusted age. This clinical experience provided a database of approximately 1700 infants to examine retrospectively for any relationship between surfactant therapy and intracranial hemorrhage. Methods. Cumulative incidence rates, hazard ratios, and 95% confidence intervals for intracranial hemorrhage were computed for each study and for appropriately pooled studies of similar design. Where an association between surfactant and the risk of intracranial hemorrhage was found, additional analyses were performed to attempt to identify intermediate physiologic events that might link administration of surfactant to the occurrence of intracranial hemorrhage. These analyses were guided by literature reports of hemodynamic changes observed in association with surfactant therapy. Results. During the controlled studies with beractant, treated newborns of 600 to 750 g birth weight were at higher risk for grades I and II intracranial hemorrhage than control newborns. There was no increased risk for grades III and IV hemorrhage among these newborns, nor was there increased risk of hemorrhage among any other patient groups. This finding did not result in increased morbidity for the affected patients; at 2 years adjusted age, they were not different from the control infants of 600 to 750 g birth weight. Retrospective examination of the database could not pinpoint the mechanism behind the finding, but it might have been related to changes in cerebral blood flow after surfactant uncompensated by ventilator management of oxygenation and ventilation. Conclusion. Surfactant therapy may set in motion hemodynamic changes that could predispose to intracranial hemorrhage in certain circumstances, but this can probably be compensated by careful management of oxygenation and ventilation. A relationship between surfactant therapy and intracranial hemorrhage is probably not isolated to any particular surfactant preparation or method of delivery; studies comparing surfactants have shown no differences in rates of intracranial hemorrhage.

The assessment of pathological changes in cerebral blood flow in hypertensive rats with stress-induced intracranial hemorrhage using Doppler OCT: Particularities of arterial and venous alterations/Die Beurteilung von pathologischen Veränderungen der Hirndurchblutung bei hypertensiven Ratten mit Stress-induzierten intrakraniellen Blutungen mittels Doppler-OCT: Besonderheiten von arteriellen und venösen Veränderungen

2013 ◽  
Vol 2 (2) ◽  
Author(s):  
Oxana V. Semyachkina-Glushkovskaya ◽  
Vladislav V. Lychagov ◽  
Olga A. Bibikova ◽  
Igor A. Semyachkin-Glushkovskiy ◽  
Sergey S. Sindeev ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Intracranial Hemorrhage ◽  
Venous Insufficiency ◽  
Hypertensive Rats ◽  
Arterial Tree ◽  
Venous Outflow ◽  
Venous Circulation ◽  
Latent Stage ◽  
Doppler Oct

AbstractHemorrhagic insult is a major source of morbidity and mortality in both adults and newborn babies in the developed countries. The mechanisms underlying the non-traumatic rupture of cerebral vessels are not fully clear, but there is strong evidence that stress, which is associated with an increase in arterial blood pressure, plays a crucial role in the development of acute intracranial hemorrhage (ICH), and alterations in cerebral blood flow (CBF) may contribute to the pathogenesis of ICH. The problem is that there are no effective diagnostic methods that allow for a prognosis of risk to be made for the development of ICH. Therefore, quantitative assessment of CBF may significantly advance the understanding of the nature of ICH. The aim of this study was to determine the particularities of alterations in arterial and venous cerebral circulation in hypertensive rats at different stages of stress-related development of ICH using three-dimensional Doppler optical coherence tomography (DOCT).Experiments were performed in mongrel adult rats. To induce ICH, hypertensive rats underwent stress (effect of severe sound, 120 dB during 2 h). To induce the renal hypertension (two kidneys, one clip) the rats were clipped at the left renal artery with a silver clip. Seven weeks after clipping, the hypertensive rats were used in the experiment. The monitoring of CBF was performed in anesthetized rats with fixed heads using a commercially available swept source OCT system (OCS1300SS; Thorlabs) in the masked period of ICH (4 h after stress) and during ICH (24 h after stress).It could be shown that in stressed rats, compared with non-stressed animals, the latent stage of stress-induced ICH (4 h after stress-off) is characterized by an increase in diameter of the superior sagittal vein with decrease in speed of the blood flow in the venous network, whereas no changes in the CBF in the arterial tree were found in this period. These facts suggest that the masked period of ICH is accompanied by decreasing venous outflow and the development of venous insufficiency. The incidence of ICH, 24 h after stress, is associated with progression of pathological alterations in cerebral venous circulation. All hypertensive rats with ICH demonstrated a greater increase in the diameter of the superior sagittal vein than stressed rats at the latent stage of ICH (in 2.5-fold,In summary, using DOCT we have shown that the latent stage of stress-induced ICH is characterized by a decrease in venous outflow. The incidence of ICH is associated with the progression of pathological alterations in cerebral venous circulation that is accompanied by a decrease in blood flow in the arterial tree. The evaluation of cerebral venous insufficiency is an important diagnostic approach for the prognosis of the risk of developing cerebral hypotension and ICH.

Neonatal Intracranial Hemorrhage and Phenobarbital

PEDIATRICS ◽  
1987 ◽  
Vol 79 (2) ◽  
pp. 315-315
Author(s):  
KARL C. K. KUBAN ◽  
ELIZABETH BROWN ◽  
ALAN LEVITON ◽  
KALPATHY KRISHNAMOORTHY
Keyword(s):  
Risk Factors ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Flow Pattern ◽  
Intracranial Hemorrhage ◽  
Double Blind Study ◽  
Inclusion Criteria ◽  
Blood Flow Pattern ◽  
Double Blind ◽  
Ultrasound Testing

In Reply.— We appreciate the comments by Dr Battisti et al. As noted in the inclusion criteria for our study,1 all intubated babies with birth weights less than 1,751 g were eligible for the study. One of the advantages of a randomized double-blind study is that babies with other risk factors, including presence of a fluctuating cerebral blood flow pattern on Doppler ultrasound testing, should have equal chances of being in the treated and placebo groups.

scholarly journals The Role of Beta-2-Adrenomediated Mechanisms of Injures of Venous Cerebral Blood Flow in Newborn Rats with Intracranial Hemorrhage

2015 ◽  
Vol 15 (2) ◽  
pp. 93-97
Author(s):  
Oksana Valerievna Semyachkina-Glushkovskaya ◽  
◽  
Marya Vasylievna Ulanova ◽  
Arkady Sergeevich Abdurashitov ◽  
Artemii Sergeevich Gekaluk ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Intracranial Hemorrhage ◽  
Newborn Rats ◽  
Beta 2

scholarly journals The Acute and Chronic Cognitive and Cerebral Blood-Flow Effects of Nepalese Pepper (Zanthoxylum armatum DC.) Extract—A Randomized, Double-Blind, Placebo-Controlled Study in Healthy Humans

Nutrients ◽  
2019 ◽  
Vol 11 (12) ◽  
pp. 3022 ◽  
Author(s):  
David Kennedy ◽  
Emma Wightman ◽  
Julie Khan ◽  
Torsten Grothe ◽  
Philippa Jackson
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Single Dose ◽  
Frontal Cortex ◽  
Task Performance ◽  
Performance Measure ◽  
Controlled Study ◽  
Double Blind ◽  
Zanthoxylum Armatum ◽  
Healthy Humans

Background: Zanthoxylum armatum DC. (ZA) is a traditional Asian culinary spice and medicinal compound, which is rich in monoterpenes and hydroxy α-sanshool. Mechanistic interactions with the monoamine, cholinergic and cannabinoid neurotransmission systems, as well as transient receptor potential (TRP) and potassium ion channels, may predispose ZA to modulate human brain function. Objectives: To investigate the effects of a single dose and 56-days supplementation with a lipid extract of ZA on cognitive function, mood and cerebral blood-flow (CBF) parameters in the pre-frontal cortex during cognitive task performance. Design: Double-blind, randomized, parallel groups study with N = 82 healthy males and females between the ages of 30 and 55 years. Assessments were undertaken pre-dose and at 1, 3 and 5 h post-dose on the first (Day 1) and last (Day 56) days of supplementation. Results: A single dose of ZA (Day 1) resulted in acute improvements on a ‘Speed of Attention’ factor and the Rapid Visual Information Processing (RVIP) task, in comparison to placebo. However, following ZA participants were less accurate on the name-to-face recall task. After 56 days of ZA consumption (Day 56), speed was enhanced on a global ‘Speed of Performance’ measure, comprising data from all of the timed tasks in the computerized battery. Participants also completed more correct Serial 3s Subtractions at the 3 h assessment and were less mentally fatigued throughout the day than participants consuming placebo. These effects were complemented on both Day 1 and Day 56 by modulation of CBF parameters, as assessed by Near Infrared Spectroscopy (NIRS). The primary finding here was a reduced hemodynamic response during the RVIP task. Conclusion: ZA improves aspects of cognitive performance, in particular the speed of performing tasks, in healthy humans and results in concomitant reductions in hemodynamic responses in the frontal cortex during task performance. The findings suggest an increase in neural efficiency following ZA.

Asymmetry of Cerebral Blood Flow Velocity in Low Birth Weight Infants

Neonatology ◽  
2005 ◽  
Vol 87 (3) ◽  
pp. 145-151 ◽  
Author(s):  
Jyothi Swarup ◽  
Robyn Wyman Baker ◽  
Beverly Sobchak Brozanski ◽  
Toby Debra Yanowitz
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Flow Velocity ◽  
Blood Flow Velocity ◽  
Cerebral Blood Flow Velocity ◽  
Low Birth Weight Infants

scholarly journals The Effect of Black Tea and Caffeine on Regional Cerebral Blood Flow Measured with Arterial Spin Labeling

2013 ◽  
Vol 33 (6) ◽  
pp. 963-968 ◽  
Author(s):  
Rishma Vidyasagar ◽  
Arno Greyling ◽  
Richard Draijer ◽  
Douglas R Corfield ◽  
Laura M Parkes
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Vascular Function ◽  
Black Tea ◽  
Cerebrovascular Reactivity ◽  
Controlled Study ◽  
Brain Vasculature ◽  
Espresso Coffee ◽  
Magnetic Resonance Imaging Mri ◽  
Double Blinded

Black tea consumption has been shown to improve peripheral vascular function. Its effect on brain vasculature is unknown, though tea contains small amounts of caffeine, a psychoactive substance known to influence cerebral blood flow (CBF). We investigated the effects on CBF due to the intake of tea components in 20 healthy men in a double-blinded, randomized, placebo-controlled study. On separate days, subjects received a single dose of 184 mg caffeine (equivalent to one strong espresso coffee), 2,820 mg black tea solids containing 184 mg caffeine (equivalent to 6 cups of tea), 2,820 mg decaffeinated black tea solids, or placebo. The CBF and cerebrovascular reactivity (CVR) to hypercapnia were measured with arterial spin labeled magnetic resonance imaging (MRI) before and 2 hours after administration. We found a significant global reduction with caffeine (20%) and tea (21%) in gray matter CBF, with no effect of decaffeinated tea, suggesting that only caffeine influences CBF acutely. Voxelwise analysis revealed the effect of caffeine to be regionally specific. None of the interventions had an effect on CVR. Additional research is required to conclude on the physiologic relevance of these findings and the chronic effects of caffeine and tea intake on CBF.

scholarly journals Cerebral blood flow regulation in end-stage kidney disease

2020 ◽  
Vol 319 (5) ◽  
pp. F782-F791
Author(s):  
Justin D. Sprick ◽  
Joe R. Nocera ◽  
Ihab Hajjar ◽  
W. Charles O’Neill ◽  
James Bailey ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Kidney Disease ◽  
Cerebral Oxygenation ◽  
Cerebrovascular Reactivity ◽  
Regulatory Mechanisms ◽  
End Stage Kidney Disease ◽  
Increased Risk ◽  
End Stage

Patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD) experience an increased risk of cerebrovascular disease and cognitive dysfunction. Hemodialysis (HD), a major modality of renal replacement therapy in ESKD, can cause rapid changes in blood pressure, osmolality, and acid-base balance that collectively present a unique stress to the cerebral vasculature. This review presents an update regarding cerebral blood flow (CBF) regulation in CKD and ESKD and how the maintenance of cerebral oxygenation may be compromised during HD. Patients with ESKD exhibit decreased cerebral oxygen delivery due to anemia, despite cerebral hyperperfusion at rest. Cerebral oxygenation further declines during HD due to reductions in CBF, and this may induce cerebral ischemia or “stunning.” Intradialytic reductions in CBF are driven by decreases in cerebral perfusion pressure that may be partially opposed by bicarbonate shifts during dialysis. Intradialytic reductions in CBF have been related to several variables that are routinely measured in clinical practice including ultrafiltration rate and blood pressure. However, the role of compensatory cerebrovascular regulatory mechanisms during HD remains relatively unexplored. In particular, cerebral autoregulation can oppose reductions in CBF driven by reductions in systemic blood pressure, while cerebrovascular reactivity to CO2 may attenuate intradialytic reductions in CBF through promoting cerebral vasodilation. However, whether these mechanisms are effective in ESKD and during HD remain relatively unexplored. Important areas for future work include investigating potential alterations in cerebrovascular regulation in CKD and ESKD and how key regulatory mechanisms are engaged and integrated during HD to modulate intradialytic declines in CBF.

Hemodynamic changes during aging associated with cerebral blood flow and impaired cognitive function

2000 ◽  
Vol 21 (2) ◽  
pp. 257-269 ◽  
Author(s):  
R.S Ajmani ◽  
E.J Metter ◽  
R Jaykumar ◽  
D.K Ingram ◽  
E.L Spangler ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Cognitive Function ◽  
Hemodynamic Changes ◽  
Impaired Cognitive Function

Effects of profound hypotension on cerebral blood flow during surgery for intracranial aneurysms

1981 ◽  
Vol 55 (6) ◽  
pp. 857-864 ◽  
Author(s):  
J. Keith Farrar ◽  
Francis W. Gamache ◽  
Gary G. Ferguson ◽  
John Barker ◽  
George P. Varkey ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Neurological Status ◽  
Neurological Deficits ◽  
Arterial Spasm ◽  
Arterial Blood ◽  
Flow Disturbances ◽  
Group I ◽  
Increased Risk ◽  
Profound Hypotension

✓ The progression of changes in cerebral blood flow (CBF) and neurological status were measured in 12 patients in whom profound hypotension (mean arterial blood pressure (MABP): 30 to 40 mm Hg) was used during intracranial aneurysm surgery. Nine patients (Group I) showed autoregulation of CBF to an MABP of 40 to 50 mm Hg during surgery. None of these patients had arterial spasm preoperatively. Postoperatively, mild flow disturbances were noted at the site of retraction. Three Group I patients developed arterial spasm postoperatively, but there was no associated neurological deterioration. The remaining three patients (Group II) had impaired autoregulation during surgery, and CBF decreased by 35% to 65% at an MABP of 50 mm Hg. Two of these patients had angiography immediately before surgery, and both showed moderate to severe arterial spasm. Relatively severe flow disturbances were noted postoperatively at the site of retraction, and two patients developed ischemic deficits of late onset. Brain retractor pressure and the degree and duration of hypotension were equivalent in the two patient groups. There was no correlation between intraoperative reductions in CBF (to as low as 20 ml/100 gm/min in the unretracted hemisphere) and immediate postoperative neurological deficits. The use of halothane and mannitol and the relatively short duration of the flow reductions were suggested as factors contributing to the protection from ischemia that was observed. Arterial spasm was found to produce hemodynamic instability and reduced CBF, although neurological status was unaffected in the majority of patients. Patients with impaired autoregulation during surgery were at increased risk of delayed ischemic complications postoperatively, and showed characteristic flow disturbances at all three stages of their clinical course.

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