Cerebral blood flow velocity in newborn infants receiving clinically indicated invasive or noninvasive ventilation

Abstract

Background

Mechanical ventilation is an essential component of the management of respiratory failure in newborn infants in the neonatal intensive care unit (NICU). The effects of invasive and noninvasive ventilation strategies on the Cerebral Blood Flow Velocity (CBFV) have not been fully studied. The objective was to assess the influence of the mode of respiratory support, invasive or noninvasive, on CBFV in newborn infants admitted to the NICU.

Methods

This is a prospective observational study of 90 neonates. Participants were allocated into three groups according to the need for respiratory support: invasive ventilation, noninvasive ventilation, and a control group. Doppler ultrasonography of the middle cerebral artery was performed at the first hour and on the third day of respiratory support.

Results

There were no statistically significant differences between the Doppler indices at the first hour of starting respiratory support between the studied groups. However, the Vmax of the middle cerebral artery was decreased significantly in the invasive mechanical ventilation group on the 3rd day of ventilation compared to the noninvasive group. Preterm infants exhibited a significant decrease in the mean values of Vmax, compared to full-term infants in the invasive group. Reduction of CBFV was reported in relation to seizures and sepsis. The cutoff value of CBFV for mortality has 100% sensitivity and 94.74% specificity.

Conclusions

In this observational study, Lower Vmax was observed among infants receiving invasive ventilation, a group that was also more premature and clinically unstable. Noninvasive ventilation was associated with stable cerebral hemodynamics.

Keywords

cerebral blood flow velocity cerebral hemodynamics Doppler US in newborn invasive ventilation newborn noninvasive ventilation PI RI Vmax

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