Cerebral haemodynamic response to somatosensory stimulation in neonatal lambs

The neurovascular coupling response has been defined for the adult brain, but in the neonate non-invasive measurement of local cerebral perfusion using near infrared spectroscopy or blood oxygen level-dependent functional magnetic resonance imaging have yielded variable and inconsistent results, including negative responses suggesting decreased perfusion and localized tissue tissue hypoxia. Also, the impact of permissive hypercapnia (P-aCO2 > 50 mmHg) in the management of neonates on cerebrovascular responses to somatosensory input is unknown. Using near infrared spectroscopy to measure changes in cerebral oxy- and deoxyhaemoglobin (Delta oxyHb, Delta deoxyHb) in eight anaesthetized newborn lambs, we studied the cerebral haemodynamic functional response to left median nerve stimulation using stimulus trains of 1.8, 4.8 and 7.8 s. Stimulation always produced a somatosensory evoked response, and superficial cortical perfusion measured by laser Doppler flowmetry predominantly increased following median nerve stimulation. However, with 1.8 s stimulation, oxyHb responses in the contralateral hemisphere were either positive (i.e. increased oxyHb), negative, or absent; and with 4.8 and 7.8 s stimulations, both positive and negative responses were observed. Hypercapnia increased baseline oxyHb and total Hb consistent with cerebral vasodilatation, and six of seven lambs tested showed increased Delta total Hb responses after the 7.8 s stimulation, among which four lambs also showed increased Delta oxyHb responses. In two of three lambs, the negative Delta oxyHb response became a positive pattern during hypercapnia. These results show that instead of functional hyperaemia, somatosensory stimulation can evoke negative (decreased oxyHb, total Hb) functional responses in the neonatal brain suggestive of decreased local perfusion and vasoconstriction, and that hypercapnia produces both baseline hyperperfusion and increased functional hyperaemia.