A way to measure cerebral blood flow in premature babies at the bedside

Researchers have discovered a novel, non-invasive way to measure blood flow to the brain of newborn children at the bedside, a method that has the potential to improve diagnosis and treatment across medicine, study suggests from Michigan Medicine.

When a fetus develops, the baby’s lungs fill with fluid, and oxygen comes directly from the placenta. This oxygenated blood bypasses the lungs to reach the rest of the body through a vessel called the ductus arteriosus.

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After birth, babies use their lungs to breathe, and the ductus arteriosus usually closes within several days. But for almost 65% of premature babies, the vessel does not close. This condition, called a patent ductus arteriosus, or PDA, diverts blood flow into an abnormal path that can strain the heart, congest the lungs, and steal blood and oxygen from the brain and other organs of the newborn baby.

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Doctors must decide whether to try to close the PDA with medication or an implanted device, both of which have risks. Accurately measuring blood flow to the newborn’s organs could help with this important decision. But a problem arises: There is no true blood flow measurement that practically works for clinical use, he said. Jonathan Rubin, M.D.Doctor.emeritus professor of radiology at the University of Michigan Medical School.

“This decision to close the patent ductus arteriosus has been an issue in neonatology for at least 30 years,” Rubin said. “The debate really hinges on how blood flow has changed, complicated by a history of unreliable data, which is why measuring blood flow is so important.”

To address this problem, Rubin and a team of Michigan Medicine researchers developed a real-time ultrasound color flow technique that relies on 3D sampling to measure blood flow. They tested the method on 10 healthy full-term infants and obtained total cerebral blood flow measurements that closely resemble those using more invasive or technically demanding techniques. The results are published in Ultrasound in Medicine and Biology.

“With our method, we can scan babies in their parents’ arms without pain or danger — no one has been able to do that before,” said Rubin, lead author of the paper.

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“Several other methods of measuring blood flow exist, but they are cumbersome and often require intravenous contrast agents, as babies are sedated or immobilized in a scanner. But premature babies are in incubators; they are fragile and these techniques can be dangerous. This ultrasound technique could be used routinely in neonatal intensive care units, which could have a significant impact on the outcomes of premature babies with this condition.”

How does it work

Many surrogate methods are used in place of true blood flow, such as blood flow velocity. But true blood flow requires knowing the velocity of the blood relative to the area it covers.

Like traffic, Rubin says, it doesn’t help to know how fast cars are moving if you don’t know how many cars are on the road.

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