The relationship between crying of premature infants with Monro-kellie hypothesis and increase of ventricular CSF Based on Doppler ultrasound findings

Abstract Introduction: Infant crying causes an increase in intracranial pressure which is equivalent to a decrease in CSF and also a decrease in CSF before ischemic and hemorrhagic strokes observed. The object of this study is to evaluate the effect of crying on premature infant brain pressure and the effect of crying on brain autoregulation. Method: In a case-control study, the participants were 53 premature infants with the ability to cry and 43 non-crying premature. Apgar score and after birth blood gases were estimated, and 200 µl capillary samples were collected from the heel for assessment of blood gases before,during and after crying. A transcranial Doppler device used to measure cerebral blood flow volume (CBFV) levels and compared in three sections during, before, and after crying. Results: The CO2 higher level was during crying in comparison with after and before crying (P<0.001). The brain volume was enlarger during crying than after and before crying, as well (P<0.001). The Doppler ultrasound results showed that the higher resistive index (RI) and pulsatility index (PI) occurred during crying than after and before crying (P<0.001). There was the lowest end-diastolic velocity (EDV) and Peak systolic velocity (PSV) during crying than after and before crying (P=0.001).Conclusion: The results suggest that the brain volume has increased during crying, which is associated with simultaneous entry of CSF. In intracranial hemorrhage (IH), there is a decrease in CSF which is accompanied by a decrease in brain activity. Therefore, crying with an increased CSF and brain magnetic activity can probably prevent IH.