Plasma Leak From the Circulation Contributes to Poor Outcomes for Preterm Infants: A Working Hypothesis

Eiby, Yvonne A., Lingwood, Barbara E., and Wright, Ian M.R. (2021) Plasma Leak From the Circulation Contributes to Poor Outcomes for Preterm Infants: A Working Hypothesis. Frontiers in Neurology, 12. 636740.

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Preterm infants are at high risk of death and disability resulting from brain injury. Impaired cardiovascular function leading to poor cerebral oxygenation is a significant contributor to these adverse outcomes, but current therapeutic approaches have failed to improve outcome. We have re-examined existing evidence regarding hypovolemia and have concluded that in the preterm infant loss of plasma from the circulation results in hypovolemia; and that this is a significant driver of cardiovascular instability and thus poor cerebral oxygenation. High capillary permeability, altered hydrostatic and oncotic pressure gradients, and reduced lymphatic return all combine to increase net loss of plasma from the circulation at the capillary. Evidence is presented that early hypovolemia occurs in preterm infants, and that capillary permeability and pressure gradients all change in a way that promotes rapid plasma loss at the capillary. Impaired lymph flow, inflammation and some current treatment strategies may further exacerbate this plasma loss. A framework for testing this hypothesis is presented. Understanding these mechanisms opens the way to novel treatment strategies to support cardiovascular function and cerebral oxygenation, to replace current therapies, which have been shown not to change outcomes.

Item ID: 70194
Item Type: Article (Research - C1)
ISSN: 1664-2295
Keywords: blood pressure, blood volume, brain oxygenation, cerebral blood flow, hypovolemia, premature infant, preterm infants, volume expansion
Copyright Information: Copyright © 2021 Eiby, Lingwood and Wright. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Funders: National Health and Medical Research Council of Australia (NHMRC)
Projects and Grants: NHMRC: APP1127142
Date Deposited: 23 Mar 2022 03:19
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