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      Is there any influence of breastfeeding on the cerebral blood flow? A review of 256 healthy newborns Translated title: Há alguma influência da amamentação sobre o fluxo sanguíneo cerebral? Estudo de 256 recém-nascidos normais

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          Abstract

          OBJECTIVE: To investigate whether breastfeeding influence the cerebral blood-flow velocity. MATERIALS AND METHODS: The present study included 256 healthy term neonates, all of them with appropriate weight for gestational age, 50.8% being female. Pulsatility index, resistance index and mean velocity were measured during breastfeeding or resting in the anterior cerebral artery, in the left middle cerebral artery, and in the right middle cerebral artery of the neonates between their first 10 and 48 hours of life. The data were analyzed by means of a paired t-test, Brieger's f-test for analysis of variance and linear regression, with p < 0.01 being accepted as statistically significant. RESULTS: Mean resistance index decreased as the mean velocity increased significantly during breastfeeding. Pulsatility index values decreased as much as the resistance index, but in the right middle cerebral artery it was not statistically significant. CONCLUSION: Breastfeeding influences the cerebral blood flow velocities.

          Translated abstract

          OBJETIVO: Investigar se a sucção ao seio materno influencia as velocidades do fluxo sanguíneo cerebral. MATERIAIS E MÉTODOS: Foram incluídos 256 neonatos saudáveis e a termo, sendo 50,8% do sexo feminino, todos com peso adequado para a idade gestacional. O índice de pulsatilidade, o índice de resistência e a velocidade média foram medidos durante ou após a amamentação na artéria cerebral anterior, artéria cerebral média esquerda e artéria cerebral média direita, entre 10 e 48 horas de vida pós-natal. Os dados foram analisados por meio de um teste t para amostras pareadas, e teste de Brieger por análise de variância e análises de regressão linear, sendo p < 0,01 aceito como significativo. RESULTADOS: Os valores do índice de resistência diminuíram à medida que a velocidade média aumentou significativamente durante a sucção ao seio materno. Os valores do índice de pulsatilidade diminuíram tanto quanto o índice de resistência, mas sem significância estatística na artéria cerebral média direita. CONCLUSÃO: A amamentação influencia as velocidades do fluxo sanguíneo cerebral.

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          Superior mesenteric artery blood flow velocity and estimated volume flow: duplex Doppler US study of preterm and term neonates.

          To obtain information about intestinal hemodynamics of healthy neonates, the authors assessed velocity and volume of blood flow with duplex Doppler sonography in the superior mesenteric artery (SMA) in 91 stable preterm and term neonates. Blood flow velocity in the SMA and estimated volume blood flow increased linearly with gestational age and increasing body weight. The mean estimated volume blood flow (+/- standard deviation) was 43 mL/kg/min +/- 13 and did not depend on differences in body weight. The authors also assessed blood flow velocity in the SMA and volume blood flow in 18 infants with conditions that may affect blood supply to the bowel. Twelve infants who were small for gestational age appeared to have an abnormally low resistance of the vascular bed of the SMA during the 1st days of life, as compared with stable appropriate-for-gestational-age infants matched for gestational age. Three of six term neonates with cardiovascular abnormalities had left ventricular outflow obstruction and an abnormal blood flow velocity waveform of the SMA, suggesting a decrease in blood supply to the bowel. The results of this study may help in evaluations of intestinal perfusion in infants with abnormal conditions.
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            Cerebral blood flow and oxidative metabolism during hypoxia and asphyxia in the new-born calf and lamb.

            1. The effects of hypoxia and asphyxia on cerebral blood flow and oxidative metabolism have been investigated in the calf and lamb under sodium pentobarbitone anaesthesia. 2. Cerebral blood flow was determined using a hydrogen clearance technique, and cerebral metabolism quantified by the simultaneous measurement of arteriocerebral venous concentration differences for oxygen, glucose and lactate. Continuous measurements were made of arterial and cerebral venous PO2 in vivo. 3. Both cerebral blood flow and oxygen consumption were less in animals anaesthetized with sodium pentobarbitone than in conscious animals. 4. In the calf, recovery from transient episodes of severe hypoxia and asphyxia was associated with a rapid recovery and overshoot of cerebral venous PO2. Evidence was obtained that rapid changes in blood pressure during severe asphyxia were associated with pressure-passive cerebral blood flow. Prolonged hypoxia (Pa,O2:21 +/- 2 mmHg) with normocapnia was associated with an increase in cerebral blood flow, fall in cerebral oxygen consumption, and no change in the glucose-oxygen index. 5. In the lamb, prolonged asphyxia (Pa,O2:30 +/- 1 mmHg; Pa,CO2:56 +/- 2 mmHg) was associated with an increase in cerebral blood flow. Cerebral glucose uptake did not change, but cerebral oxygen consumption was markedly depressed, and the glucose-oxygen index increased. 6. In the lamb during normoxia, there was a linear correlation between cerebral blood flow and arterial PCO2 in the range 10-95 mmHg (r = 0.92; P < 0.001), with a slope of 1.74 ml. 100g-1 min-1 . mmHg Pa,CO2-1 . Hypoxia did not significantly increase the fall in cerebral vascular resistance associated with a rise in Pa,CO2 from 34 to 56 mmHg.
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              Cerebrovascular regulation and vasoneuronal coupling.

              Maintenance of cerebral perfusion pressure is a prerequisite for the prevention of cerebral ischemia. Physiological fluctuations in systemic perfusion pressure are compensated by cerebrovascular autoregulation. Cerebral hypoperfusion could result from (1) systemic hemodynamic failure (eg, distal to severe arterial stenosis), overcharging the vasoregulatory capacity; (2) dysfunction and exhaustion of cerebrovascular autoregulation; or (3) both. Ultrasound offers an excellent temporal resolution, is noninvasive, and is easily applicable for follow-up investigations. Despite its poor spatial resolution, transcranial Doppler sonography has been used for determination of cerebral perfusion reserve studies measuring cerebral blood flow velocity (CBFV) during hypercapnia or application of vasoactive agents (eg, acetazolamide). This approach evaluates vasomotor regulation in patients with hemodynamic compromise distal to severe stenosis or occlusion of the brain supplying arteries. Monitoring CBFV during tilt table examinations directly measures cerebral autoregulation. In patients with systemic orthostatic hypotension, maintainance or failure of cerebrovascular compensation and, even more importantly, cerebrovascular dysautoregulation, despite normal systemic blood pressure regulation, may be demonstrated. Vasoneuronal coupling is reflected by CBFV variations during appropriate neuronal stimulation. Neuronal dysfunction is associated with CBFV abnormalities as exemplified by preconditions of focal cerebral dysfunction in the posterior cerebral artery (PCA) in migraineurs with aura, where massive alteration of vasoneuronal coupling and ischemia is threatening during spreading depression. A highly significant asymmetric gain of vasoneuronal coupling in the interictal state may act as a trigger mechanism in these patients. Testing for vasoneuronal coupling within the middle cerebral artery (MCA) territory is more difficult due to the poor spatial resolution with various neuronal stimuli (eg, motorsensory or cognitive paradigms), only eliciting local neuronal areas underrepresented in the MCA CBFV global changes. However, motor stimulation evoked CBFV may be used to indicate dysintegration of vasoneuronal coupling in the course of acute cerebral ischemia with sensorimotor hemiparesis and, moreover, seems to be of prognostic value regarding the motor deficit.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                rb
                Radiologia Brasileira
                Radiol Bras
                Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (São Paulo )
                1678-7099
                October 2012
                : 45
                : 5
                : 263-266
                Affiliations
                [1 ] Universidade do Estado do Rio de Janeiro Brazil
                [2 ] Universidade Federal do Rio de Janeiro Brazil
                [3 ] Universidade do Estado do Rio de Janeiro Brazil
                Article
                S0100-39842012000500006
                10.1590/S0100-39842012000500006
                5689fe6e-c84b-4c30-aaf7-cf0227852c7c

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0100-3984&lng=en
                Categories
                RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

                Radiology & Imaging
                Cerebral blood flow,Breastfeeding,Doppler ultrasonography,Neonates,Fluxo sanguíneo cerebral,Amamentação,Ultrassom Doppler,Neonatos

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