Brain function after near-term birth. The effects of hypoxemia and hypotension.
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[S.l. : s.n.]
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RU Radboud Universiteit Nijmegen, 3 oktober 2005
Promotor : Bor, M. van de
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Paediatrics - OUD tm 2017
SubjectUMCN 2.1: Heart, lung and circulation
This thesis describes the effects of hypoxemia and hypotension on brain cell function and brain metabolism in the near-term born lamb. Electrocortical brain activity (ECBA), which was used as a measure of brain cell function, was correlated to measures of energy failure and brain cell damage. Lambs were delivered near-term. Hypoxemia was induced by stepwise reduction of the inspired oxygen concentration. Hypotension was induced by stepwise withdrawal of blood. Flow in the left carotid artery and cerebral arterial blood gases were determined at the end of each hypoxemic or hypotensive level to calculate cerebral O2-supply. Furthermore, changes in cerebral O2-supply were monitored with near-infrared spectroscopy. For each individual lamb, the threshold of cerebral O2-supply for maintenance of ECBA was calculated. The concentrations of purines, pyrimidines and excitatory amino acids were determined in liquor cerebrospinalis. Overall threshold levels of cerebral O2-supply for the maintenance of ECBA were significantly different (p<0.02) between hypoxemic and hypotensive near-term lambs. During hypoxemia and hypotension, ECBA was significantly negatively related to the concentrations of purines, pyrimidines and excitatory amino acids. We conclude that brain cell function is likely to be more susceptible for deterioration when cerebral O2-supply is the consequence of hypoxemia than when it is caused by hypotension. We would like to emphasize that maintaining cerebral O2-supply in near-term neonates that suffered from hypoxemia and/or hypotension is of utmost importance.
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