Cerebral autoregulation and cerebrovascular injury in preterm infants: modern views on pathogenesis, diagnosis and preventive strategies

T.V. Kurilina

Abstract


The review of scientific sources is directed at covering the achievements in understanding the features of cerebral perfusion autoregulation in prematurely born children, establishing the scope of modern methods of its monitoring and determining common approaches to the prevention of cerebrovascular disorders. The article deals with the history of investigation of cerebral vascular reactivity and the function of internal neuroprotective physiological phenomenon — cerebral autoregulation, in accordance with the latest international studies. A set of integrated mechanisms of cerebral autoregulation is reviewed. Studies about the role of myogenic, neurogenic and metabolic mechanisms, as well as their disorders in prematurely born children are presented. According to the data presented in the studies, immaturity of autoregulatory mechanisms, anatomical features of the brain tissue, plenty of internal and external factors affecting cerebrovascular structures cause a high risk of damage to the central nervous system in preterm infants. Efforts of researchers are directed at the development of non-invasive diagnostic technologies that can help to monitor cerebral oxygenation for a long time and promote timely correction of therapeutic approaches. Near-infrared spectroscopy is relatively new method in intensive neonatology, which already proved its safety and effectiveness in tactical decision making during the care of prematurely born children. Reference values of cerebral oxygenation obtained for preterm infants of different gestational age, which can be used in the practice of intensive neonatology to optimize infusion therapy and respiratory support of children at the preclinical stage of cerebrovascular damage, are presented in the review. The article considers issues about the diagnosis of hypotension in premature newborns, certain pharmacological approaches for the prevention and treatment of cerebral circulatory disorders.

Keywords


preterm infant; cerebral autoregulation; near-infrared spectroscopy; cerebral regional oxygenation; cerebrovascular injuries; pathogenesis; diagnosis; review

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DOI: https://doi.org/10.22141/2224-0551.13.2.2018.129555

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