Abstract
The adult Cushing reflex is an increase in blood pressure (BP) and a decrease in heart rate (HR) in response to elevated CSFP. Is this response seen in neonates during IVH? Cardiovascular responses to simulated IVH were studied in anesthetized piglets ≤24 hours old. CSFP, BP, HR and phasic femoral, carotid and renal flows were recorded; resistance (R) was calculated as BP/mean flow. Every 10 minutes 0.5ml of the animal's own blood (IVH,n=6) or artificial CSF (n=3) was injected into the right lateral ventricle. With IVH, CSFP increased 10-20cm H2O with each injection; peak CSFP was 90cm H2O with IVH and 40cm H2O with CSF. HR responses were variable. Consistent changes in BP were not elicited until a total volume of 2.5ml had been injected in all animals. Immediate increases in BP after IVH were 28%, 53% and 95% with totals of 2.5, 5.0 and 7.5ml of blood injected, while with CSF, the BP increases averaged 21% with 2.5-7.5ml injected. Femoral R increased 37%, 101% and 168% and renal increased 37%, 88% and 153% with 2.5, 5.0 and 7.5ml respectively. With CSF, femoral and renal R were variable. Carotid R increased in all animals. Our results indicate that the HR decrease accompanying the BP increase with elevated CSFP is not consistently present in neonates. Thus, the adult Cushing reflex is not obtained in neonates. Furthermore, careful monitoring of cardiovascular parameters is essential in the care of infants susceptible to IVH.
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Gootman, N., Weinhouse, E., Gootman, P. et al. 1311 CARDIOVASCULAR RESPONSES TO INCREASED CEREBROSPINAL FLUID PRESSURE (CSFP) BY SIMULATED INTRAVENTRICULAR HEMORRHAGE (IVH) IN 1 DAY OLD PIGLETS. Pediatr Res 15 (Suppl 4), 661 (1981). https://doi.org/10.1203/00006450-198104001-01340
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DOI: https://doi.org/10.1203/00006450-198104001-01340