Regulation of Cerebral Blood Flow in Very Low Birth Weight Infants - Full Text View

Sponsors and Collaborators:	University of Arkansas National Institute of Neurological Disorders and Stroke (NINDS)
Information provided by:	University of Arkansas
ClinicalTrials.gov Identifier:	NCT00579943

Purpose

Advances in newborn intensive care have lead to dramatic improvements in survival for the most premature infants—often weighing 1 pound at birth. Unfortunately, cerebral palsy, mental retardation, and developmental delay affect more than 10,000 of these premature infants in the U.S. annually. In his studies, Dr. Jeffrey R.

Kaiser is trying to understand why these premature infants are at such high risk of brain injury, and to learn ways to prevent injury. Experts believe that disturbances of brain blood flow regulation are important in causing these injuries. Using a novel continuous monitoring system, Dr. Kaiser is able to determine an infant's capacity for normal brain blood flow regulation. Contrary to previous thinking, he has shown that many of these babies in fact due have normal regulation of their brain blood flow. He has observed that brain blood flow may be disturbed during suctioning of the breathing tube. Further, he has also shown that infants with high carbon dioxide, those not breathing well, have impaired regulation of their brain blood flow. Thus, even stable infants are prone to disturbed brain regulation during routine intensive care, which may lead to bleeding in the brain and long-term neurologic problems. Dr. Kaiser will study up to 200 infants to determine 1) the developmental pattern of normal regulation of cerebral blood flow; 2) in those with impaired regulation, determine when it develops during the first week of life; and 3) determine the relationship between impaired brain blood flow regulation and brain injury. Results from this study will help us recognize when premature infants are most vulnerable to developing brain injury, allowing prevention and intervention strategies to be initiated in a timely fashion.

Condition
Infant, Very Low Birth Weight Infant, Premature, Diseases Cerebral Hemorrhage

Study Type:	Observational
Study Design:	Cohort, Prospective
Official Title:	Development of Cerebral Autoregulation in Very Low Birth Weight Infants

Resource links provided by NLM:

MedlinePlus related topics: Premature Babies Traumatic Brain Injury

U.S. FDA Resources

Further study details as provided by University of Arkansas:

Primary Outcome Measures:

Determine when a premature infant develops the capacity for intact cerebral autoregulation [ Time Frame: First week of life ] [ Designated as safety issue: No ]

Secondary Outcome Measures:

Determine how hypercapnia affects the capacity for intact autoregulation [ Time Frame: First week of life ] [ Designated as safety issue: No ]
Determine if impaired autoregulation is associated with brain injury [ Time Frame: First week of life ] [ Designated as safety issue: No ]

Biospecimen Retention: None Retained

Biospecimen Description:

Estimated Enrollment:	200
Study Start Date:	May 2001
Study Completion Date:	June 2008
Primary Completion Date:	June 2008 (Final data collection date for primary outcome measure)

Groups/Cohorts
premature infants Inpatient very low birth weight infants who are ventilated and have an umbilical arterial catheter in place

Detailed Description:

This proposal outlines a program to study the development of cerebral autoregulation in very low birth weight (VLBW) (less than 1500 grams birth weight) infants, and its role in brain injury. Despite improvements in intensive care, brain injury in VLBW infants remains a significant health problem. This is due to the increasing incidence of prematurity and increasing survival rates of those VLBW infants most prone to developing intraventricular hemorrhage. Overwhelming evidence suggests that disturbances of autoregulation are important in the pathogenesis of these injuries. Autoregulation is a mechanism that maintains constant blood flow to the brain despite wide variations in blood pressure. However, because previous studies have pooled data from infants with different gestational and postnatal ages, little is known about how autoregulation develops in VLBW infants. A novel monitoring system will be used to test the central hypotheses that cerebral autoregulatory capacity in VLBW infants is developmentally acquired and that its disruption is associated with brain injury. The ontogenetic profile of autoregulatory capacity in VLBW infants will be determined. In those who lack autoregulation, the postnatal time course for development will be assessed. Then the relationship between the absence of autoregulation and brain injury will be established. Two hundred VLBW infants who have normal findings on a cranial ultrasound on day of life 1 will be enrolled. Continuous 1-hour measurements of cerebral blood flow velocity (transcranial Doppler ultrasound) will be compared to simultaneous measurements of blood pressure using multivariate analysis, after adjusting for variations in arterial blood gases (continuous blood gas monitor), to determine autoregulatory capacity (twice daily during the first 3 days of life and once on days 4-7). Results will be analyzed for each individual and for gestational age groups (23-25, 26-28, and greater than 29 weeks').

Results from this study will help us recognize when VLBW infants are most vulnerable to developing brain injury, allowing prevention and intervention strategies to be initiated in a timely fashion. Dr. Jeffrey Kaiser will take advantage of the strong mentoring, protected research time and outstanding academic resources of the University of Arkansas for Medical Sciences to reach his goal of becoming an independent investigator.

Eligibility

Ages Eligible for Study:	up to 7 Days
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No
Sampling Method:	Non-Probability Sample

Study Population

Neonatal Intensive Care Unit

Criteria

Inclusion Criteria:

Very low birth weight infants, ventilated, umbilical arterial catheter in place

Exclusion Criteria:

Infants with serious congenital anomalies and chromosomal abnormalities
Infants not intubated
Infants without umbilical arterial catheter
Infants without parental consent

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00579943

Locations

United States, Arkansas
University of Arkansas for Medical Sciences
Little Rock, Arkansas, United States, 72205

Sponsors and Collaborators

University of Arkansas

National Institute of Neurological Disorders and Stroke (NINDS)

Investigators

Principal Investigator:

Jeffrey R. Kaiser, MD, MA

University of Arkansas

More Information

Publications:

Kaiser JR. Both extremes of arterial carbon dioxide pressure and the magnitude of fluctuations in arterial carbon dioxide pressure are associated with severe intraventricular hemorrhage in preterm infants. Pediatrics. 2007 May;119(5):1039; author reply 1039-40. No abstract available.

Kaiser JR, Gauss CH, Pont MM, Williams DK. Hypercapnia during the first 3 days of life is associated with severe intraventricular hemorrhage in very low birth weight infants. J Perinatol. 2006 May;26(5):279-85.

Kaiser JR, Gauss CH, Williams DK. The effects of hypercapnia on cerebral autoregulation in ventilated very low birth weight infants. Pediatr Res. 2005 Nov;58(5):931-5.

Kaiser JR, Gauss CH, Williams DK. Surfactant administration acutely affects cerebral and systemic hemodynamics and gas exchange in very-low-birth-weight infants. J Pediatr. 2004 Jun;144(6):809-14.

Responsible Party:	University of Arkansas for Medical Sciences ( Jeffrey R. Kaiser, MD, MA Associate Professor )
Study ID Numbers:	05594, 1K23NS043185
Study First Received:	December 19, 2007
Last Updated:	June 3, 2008
ClinicalTrials.gov Identifier:	NCT00579943 History of Changes
Health Authority:	United States: Institutional Review Board

Keywords provided by University of Arkansas:

very low birth weight infant
cerebral autoregulation
intraventricular hemorrhage
carbon dioxide

cerebral blood flow velocity
ultrasonography, Doppler, transcranial
cerebrovascular circulation

Study placed in the following topic categories:

Body Weight
Birth Weight
Signs and Symptoms
Cerebral Hemorrhage
Vascular Diseases
Infant, Newborn, Diseases

Central Nervous System Diseases
Infant, Premature, Diseases
Intracranial Hemorrhages
Brain Diseases
Hemorrhage
Cerebrovascular Disorders

Additional relevant MeSH terms:

Birth Weight
Cerebral Hemorrhage
Nervous System Diseases
Vascular Diseases
Central Nervous System Diseases
Infant, Premature, Diseases
Intracranial Hemorrhages
Hemorrhage

Brain Diseases
Cerebrovascular Disorders
Body Weight
Signs and Symptoms
Pathologic Processes
Infant, Newborn, Diseases
Cardiovascular Diseases

ClinicalTrials.gov processed this record on September 10, 2009