A Novel Method for Assessing Cerebral Autoregulation in Preterm Infants Using Transfer Function Analysis

BACKGROUND: Autoregulatory dysfunction is an important contributor to brain injury in premature infants, particularly intraventricular hemorrhage (IVH). The autoregulatory system acts as a filter that dampens the systemic blood flow to follow a normal cerebral perfusion profile. METHODS: Simultaneous arterial blood pressure and cerebral near infrared spectroscopy (NIRS) data were collected from infants born before 28 weeks estimated gestational age (EGA). The resulting data were preprocessed and then divided into non-overlapping 20-minute epochs. The transfer function estimate was calculated to determine dampening ability. RESULTS: 62 infants were prospectively recruited with a mean EGA of 25.4 ± 1.3 weeks and birth weight of 832 ± 199g. 67% were male, 24/62 had IVH, 17/62 received dopamine, 47/62 had antenatal steroid exposure, and 22/62 received fentanyl. Advancing EGA and birth weight z-score predicted stronger dampening while African-American race and IVH of any grade predicted weaker dampening. CONCLUSION: This preliminary report suggests an impairment in dampening ability associated with immaturity, decreased birth weight z-score and African-American race. Decreased dampening is also associated with IVH, although these results cannot distinguish between decreased dampening as an antecedent or sequela of IVH. These observations should be studied in a larger sample.