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Continuous Invasive Blood Pressure is Directly Related to EEG Measures of Continuity in Extremely Preterm Infants in the First Three Days of Life

Presented at the Neonatal Society 2013 Autumn Meeting.

Pereira SS1, Kempley ST2, Wertheim D3, Sinha AK1, Shah DK1

1 Neonatal Intensive Care Unit, The Royal London Hospital, Barts Health NHS Trust, UK
2 Queen Mary University of London, UK
3 Kingston University; London, UK

Background: Electroencephalographic (EEG) activity may be affected by changes in cerebral perfusion in extremely preterm infants (1) so that a reduction in cerebral perfusion may be associated with reduced electrocortical activity. The relationship between invasively measured systemic blood pressure and EEG activity in this group remains to be determined. We hypothesised that systemic blood pressure and cerebral perfusion are directly related to measures of EEG continuity.in extremely preterm infants in the first three days of life.

Methods: Infants born <29 weeks gestation were prospectively recruited within 12 hours of birth. They had continuous invasive arterial blood pressure and amplitude-integrated EEG (aEEG) recording. Cross cerebral aEEG was assessed for minimum and maximum amplitude, measures of lower and upper aEEG margin, percentage of time minimum amplitude below 5 microvolts and for seizures. Left ventricular output (LVO), common carotid artery blood flow (CCAF) and mean arterial blood pressure (averaged over a 2 hour epoch) were related to EEG measures over the same epoch. Non-parametric correlation and multiple linear regression analysis were used for analysis (SPSS v21). Research ethics approval (12/LO/1553) and written parental consent were obtained.

Results: Median (range) gestation and birthweight were 25.8 (23.4-28.9) weeks and 735 (515-1470) grams respectively. In simple rank correlation, all EEG parameters were significantly associated with blood pressure on Days 1 and 3, and with gestation on Day 1. In stepwise multiple regression analysis, only blood pressure was retained.

Continuous Invasive Blood Pressure is Directly Related to EEG Measures of Continuity in Extremely Preterm Infants in the First Three Days of Life

Conclusion: We found a strong relationship between continuous systemic mean arterial blood pressure and measures of EEG continuity, suggesting that at lower blood pressures there is an increase in EEG discontinuity.

Corresponding author: sujithpereira@nhs.net

References
1. West CR, Groves AM, Williams CE, Harding JE, Skinner JR, Kuschel CA, Battin MR. Early low cardiac output is associated with compromised electroencephalographic activity in very preterm infants. Pediatr Res. 2006; 59: 610-5

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