Cerebral metabolism in the very low birth weight infant

Abstract

The preterm brain undergoes significant structural and functional changes throughout the third trimester. These changes require a constant supply of energy which is provided predominantly in the form of glucose. Alterations in this natural process can result in lifelong consequences for the very low birth weight infant. In this chapter the reader is provided with an insight into some of the neuroimaging modalities available to assess structural and functional changes in the preterm brain as well as an insight into the assessment of cerebral glucose transport and glucose metabolism in the very low birth weight infant. A review is provided of the assessment of cerebral blood flow and cerebral oxygen consumption in the very low birth weight infant followed by some of the processes that may interfere with normal cerebral metabolism in the preterm very low birth weight infant. The preterm brain has low energy requirements which coupled with low cerebral blood flow, means that the immature brain has the ability to deal with many significant alterations in cerebral metabolism. However, despite these factors many conditions can disrupt normal metabolism and result in brain injury. The last 30 years have witnessed significant improvements in survival of extremely preterm infants; the focus has now shifted towards improved quality of life in survivors. A better understanding of normal cerebral metabolism will allow one to identify alterations in this process and hence direct intervention, with the ultimate goal being improved long-term neurodevelopmental outcome.