Blood flow to the head and arms was measured by a new volumetric Doppler technique in 30 preterm infants and 10 full term infants. At least 80% of this blood flow is considered to perfuse the brain. At the same time mean blood velocity in the middle and anterior cerebral arteries was measured by Duplex Doppler scanning. While blood flow to the head and arms remained substantially constant in both groups over the first 48 hours of life (60 ml/100 g brain weight/min), blood velocity doubled in both cerebral arteries in the preterm group. The term infants had higher blood velocities in both arteries at all times, but the velocities also increased over 48 hours, although to a lesser extent than in the preterm group. These findings imply that the major intracranial arteries are themselves vasoactive, being dilated at birth and subsequently constricting, possibly as an autoregulatory response to rising arterial blood pressure. While vasodilated, the cerebral arteries will be less efficient at damping pressure transients, placing preterm infants at particular risk of periventricular haemorrhage during the early hours of life. The implications for possible approaches to the prevention of cerebral haemorrhage are discussed.
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