Adre du Plessis, MD
Associate
Professor of Neurology
Harvard Medical School/Children's Hospital
MRRC Project(s)
P01 NS38475-01
Periventricular Leukomalacia in the Premature Infant
PI, Project 1: Cerebrovascular Autoregulation and PVL in Premature Infants
The emphasis of this research program is the relation of cerebral hemodynamics to the occurrence of neonatal brain injury. We have studied particularly infants undergoing cardiac surgery with cardiopulmonary bypass for correction of serious congenital heart disease, in part because this clinical situation provides a unique model of hypoxic-ischemic insult in the human infant. We have capitalized on state-of-the-art techniques, such as near-infrared spectroscopy (NIRS), which can be utilized to study noninvasively, continuously, and in vivo cerebral hemodynamics and oxygen metabolism in such infants. The major goals of this research have included: 1) to define the mechanisms of hypoxic-ischemic injury developing during deep hypothermic infant cardiac surgery, 2) to perform carefully designed parallel experimental studies in a piglet model of deep hypothermic circulatory arrest, 3) to delineate the integrity of cerebral vasoregulation after cardiac surgery and its role in the brain injury occurring in this population, and 4) to define in detail the clinical manifestations and long-term outcome of brain injury sustained during infant cardiac surgery. More recently, our research focus has included brain injury in the preterm infant; this work is a natural extension of our experience with infants undergoing cardiac surgery. The aims of the research in the preterm infant are: 1) to utilize NIRS in premature infants with progressive post-hemorrhagic hydrocephalus to define when critical cerebral ischemia commences, and 2) to identify, by means of simultaneous systemic blood pressure and NIRS cerebral perfusion measurements, preterm infants with impaired cerebrovascular autoregulation who are at high risk for periventricular leukomalacia and/or intraventricular hemorrhage.
