Regional Blood Flow Distribution and Left Ventricular Output during Early Neonatal Life|[colon]| A Quantitative Ultrasonographic Assessment

摘要

To examine the serial changes of left ventricular output and regional blood flow distribution during the early neonatal period, we measured blood flow volume in the ascending aorta, middle cerebral artery, celiac artery, superior mesenteric artery, and renal artery in 23 normal term infants at 1, 4--8, 24, and 96 h after birth. The blood flow volume in each vessel was measured by the pulsed Doppler technique. In the middle cerebral artery, celiac artery, and superior mesenteric artery, the blood flow volume at 1 and 4--8 h of age was significantly lower than after 24 h of age. In contrast, renal artery blood flow volume did not change significantly throughout the study period. The reduced organ blood flow volume soon after birth was related to a low diastolic blood flow in the major vessels, and the percent diastolic integral of blood flow velocity in each vessel showed an inverse linear correlation with the diameter of the ductus arteriosus. The left ventricular output 1 h after birth was 365 ± 69 mL/kg/min, which was significantly higher than after 4-8 h of age. Left ventricular output gradually declined to 301 ± 63 mL/kg/min at 4—8 h of age (p versus 96 h), 272 ± 48 mL/kg/min at 24 h, and 258 ± 54 mL/kg/min at 96 h. There was a significant positive correlation between left ventricular output and the ductus arteriosus diameter. We concluded that 1) there were significant changes in organ blood flow during the period of ductal closure, 2) the high left ventricular output and reduced regional blood flow at 1 and 4—8 h after birth resulted from diastolic left-to-right shunting through the ductus arteriosus, and 3) left ventricular output and regional organ blood flow were not directly related to each other. Our findings on the changes in regional organ blood flow and left ventricular output may provide a useful basis for interpreting abnormal hemodynamics in the early postnatal period.