Impaired cerebral autoregulation and brain injury in newborns with hypoxic-ischemic encephalopathy treated with hypothermia

Massaro, An N.; Govindan, Rathinaswamy B.; Vézina, Gilbert; Chang, Taeun; Andescavage, Nickie; Wang, Yunfei; Al-Shargabi, Tareq; Metzler, Marina; Harris, Kari Jo; Plessis, Adré J. du

doi:10.1152/jn.00353.2015

Cited by 77 publications

(74 citation statements)

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“…Coherence, gain, and wavelet coherence analyses of cerebral NIRS and MAP have also shown an association with neurological injury in HIE. 4,25 Additionally, optimal MAP has been identified in premature neonates using correlation between slow waves of heart rate and NIRS tissue oxygenation index. 26 Whether one method or a combinative value is superior has not been fully studied.…”

Section: Discussionmentioning

confidence: 99%

“…This finding likely impacted our ability to detect relationships during hypothermia as the first 24 to 36 hours of life is vulnerable to dysfunctional autoregulation after HIE. 4 We identified optimal MAP during all of hypothermia, rewarming, or the first six hours of normothermia rather than using shorter time intervals as in adult brain trauma studies of optimal cerebral perfusion pressure. 29 We conservatively identified optimal MAP from the HVx versus MAP bar graphs only when there was an apparent nadir in HVx.…”

Section: Discussionmentioning

confidence: 99%

“…Cerebral vasoreactivity describes the vasodilatory and vasoconstrictive responses to changes in blood pressure that mediate cerebral blood flow autoregulation. Dysfunctional vasoreactivity and autoregulation during resuscitation, 3 hypothermia, 4 and rewarming 5,6 may contribute to secondary brain injury and poor neurological outcomes in HIE.…”

Section: Introductionmentioning

confidence: 99%

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Cerebral Autoregulation and Conventional and Diffusion Tensor Imaging Magnetic Resonance Imaging in Neonatal Hypoxic-Ischemic Encephalopathy

Carrasco

Perin²,

Jennings³

et al. 2018

Pediatric Neurology

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Background Deviation of mean arterial blood pressure (MAP) from the range that optimizes cerebral autoregulatory vasoreactivity (optimal MAP) could increase neurological injury from hypoxic-ischemic encephalopathy (HIE). We tested whether a global magnetic resonance imaging (MRI) brain injury score and regional diffusion tensor imaging (DTI) are associated with optimal MAP in neonates with HIE. Methods Twenty-five neonates cooled for HIE were monitored with the hemoglobin volume index. In this observational study, we identified optimal MAP and measured brain injury by qualitative and quantitative MRIs with the Neonatal Research Network (NRN) score and DTI mean diffusivity scalars. Optimal MAP and blood pressure were compared with brain injury. Results Neonates with blood pressure within optimal MAP during rewarming had less brain injury by NRN score (P = 0.040). Longer duration of MAP within optimal MAP during hypothermia correlated with higher mean diffusivity in the anterior centrum semiovale (P = 0.008) and pons (P = 0.002). Blood pressure deviation below optimal MAP was associated with lower mean diffusivity in cerebellar white matter (P = 0.033). Higher optimal MAP values related to lower mean diffusivity in the basal ganglia (P = 0.021), the thalamus (P = 0.006), the posterior limb of the internal capsule (P = 0.018), the posterior centrum semiovale (P = 0.035), and the cerebellar white matter (P = 0.008). Optimal MAP values were not associated with the NRN score. Conclusions The NRN score and the regional mean diffusivity scalars detected injury with mean arterial blood pressure deviations from the optimal MAP. Higher optimal MAP and lower mean diffusivity may be related because of cytotoxic edema and limited vasodilatory reserve at low MAP in injured brain. DTI detected injury with elevated optimal MAP better than the NRN score.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cerebral Autoregulation and Conventional and Diffusion Tensor Imaging Magnetic Resonance Imaging in Neonatal Hypoxic-Ischemic Encephalopathy

Carrasco

Perin²,

Jennings³

et al. 2018

Pediatric Neurology

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“…Many complicating clinical factors have been linked to causing or worsening the dysfunction of the autoregulatory system including hypotension (20), hypoxic-ischemia (57, 58), seizures (59), inotropic medications (60), and possibly even IVH itself (21). …”

Section: Link Between Dysfunction In Autoregulation and Brain Injurymentioning

confidence: 99%

Cerebral Autoregulation, Brain Injury, and the Transitioning Premature Infant

Vesoulis

Mathur

2017

Front. Pediatr.

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Improvements in clinical management of the preterm infant have reduced the rates of the two most common forms of brain injury, such as severe intraventricular hemorrhage and white matter injury, both of which are contributory factors in the development of cerebral palsy. Nonetheless, they remain a persistent challenge and are associated with a significant increase in the risk of adverse neurodevelopment outcomes. Repeated episodes of ischemia–reperfusion represent a common pathway for both forms of injury, arising from discordance between systemic blood flow and the innate regulation of cerebral blood flow in the germinal matrix and periventricular white matter. Nevertheless, establishing firm hemodynamic boundaries, as a part of neuroprotective strategy, has challenged researchers. Existing measures either demonstrate inconsistent relationships with injury, as in the case of mean arterial blood pressure, or are not feasible for long-term monitoring, such as cardiac output estimated by echocardiography. These challenges have led some researchers to focus on the mechanisms that control blood flow to the brain, known as cerebrovascular autoregulation. Historically, the function of the cerebrovascular autoregulatory system has been difficult to quantify; however, the evolution of bedside monitoring devices, particularly near-infrared spectroscopy, has enabled new insights into these mechanisms and how impairment of blood flow regulation may contribute to catastrophic injury. In this review, we first seek to examine how technological advancement has changed the assessment of cerebrovascular autoregulation in premature infants. Next, we explore how clinical factors, including hypotension, vasoactive medications, acute and chronic hypoxia, and ventilation, alter the hemodynamic state of the preterm infant. Additionally, we examine how developmentally linked or acquired dysfunction in cerebral autoregulation contributes to preterm brain injury. In conclusion, we address exciting new approaches to the measurement of autoregulation and discuss the feasibility of translation to the bedside.

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“…Результаты ис-следований у перенесших асфиксию доношенных детей выявили увеличение объема крови, наруше-ние ауторегуляции и скорости мозгового кровотока, предшествующее развитию энергетической недо-статочности метаболических процессов, что изме-няет функциональное состояние мозговых струк-тур [57]. Показано, что мониторинг оксигенации мозга у детей, получающих гипотермию, позволяет уже в первые 10 часов жизни прогнозировать небла-гоприятный исход или наметить дальнейшую стра-тегию лечения церебральной ишемии [32,36,55]. Сопоставление результатов мониторинга цере-бральной сатурации кислорода с клиническим со-стоянием новорожденных и с последствиями пе-ринатальной патологии указало необходимость его проведения для раннего прогноза и выбора своевре-менной корригирующей терапии [3, 23,54].…”

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Сerebral oxymetry in neonatology

Evsyukova

2017

Pediatr (SPb)

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The frequency of disturbance the functional development of newborn brain after intrauterine and birth asphyxia determines the necessity the finding objective methods of timely diagnosis the alteration of brain oxygenation for the target therapy. During last years the special attention of investigators was attracted to use for this purpose in newborns the noninvasive, informative and portable method near-infrared spectroscopy (NIRS). Cerebral oxymetry successfully used for estimation brain circulation of the blood and blood volume in the brain vessels with combination constant monitoring blood pressure. This review outlines the basic principles, advantages NIRS technology in clinical studies brain oxygenation in healthy full term and premature newborns and also after asphyxia, vacuum extraction and cesarean section. Monitoring brain oxygenation in newborns which received cooling after heavy asphyxia permits during first 10 hours after birth to prognosis unfavorable outcome or fix the further strategy of treatment cerebral ischemia. Presented clinical use this method for treatment premature newborns with respiratory distress and circulatory insufficiency. It may help to determine the optimal target oxygen saturation. It is alsow useful monitoring during intensive therapy of extremely preterm neonates, due to the risk of impaired cerebral blood flow auto regulation in these patients. Indicated the perspectives of cerebral oxymetry in neonato logy for new diagnostic, treatment and prophylactic perinatal CNS damage.

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Impaired cerebral autoregulation and brain injury in newborns with hypoxic-ischemic encephalopathy treated with hypothermia

Abstract: du Plessis AJ. Impaired cerebral autoregulation and brain injury in newborns with hypoxic-ischemic encephalopathy treated with hypothermia.

Cited by 77 publications

References 40 publications

Cerebral Autoregulation and Conventional and Diffusion Tensor Imaging Magnetic Resonance Imaging in Neonatal Hypoxic-Ischemic Encephalopathy

Cerebral Autoregulation and Conventional and Diffusion Tensor Imaging Magnetic Resonance Imaging in Neonatal Hypoxic-Ischemic Encephalopathy

Cerebral Autoregulation, Brain Injury, and the Transitioning Premature Infant

Сerebral oxymetry in neonatology

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