Cerebral Blood Flow of the Neonatal Brain after Hypoxic–Ischemic Injury

Tierradentro-García, Luis Octavio; Saade-Lemus, Sandra; Freeman, Colbey W.; Kirschen, Matthew; Huang, Hao; Vossough, Arastoo; Hwang, Misun

doi:10.1055/s-0041-1731278

Cited by 12 publications

(5 citation statements)

References 145 publications

(258 reference statements)

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“…Grayscale US is the standard of care and allows detection of major cerebrovascular events such as hemorrhage [ 21 , 22 ]. MVI supplements conventional tools such as grayscale US by providing functional insights into the brain, namely helping to measure cerebral blood flow and its surrogate which are important in assessing tissue viability and risk of injury [ 23 , 24 , 25 ]. As compared to transcranial Doppler (TCD), which helps assess macrovascular flow dynamics, MVI helps assess microvascular flow dynamics which is an important advantage in ECMO patients at higher risk of acute cerebrovascular events related to the circuit, anticoagulation, and/or underlying condition [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

Utility of Cerebral Microvascular Imaging in Infants Undergoing ECMO

et al. 2022

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Purpose: Infants who require extracorporeal membrane oxygenation (ECMO) therapy have an increased risk of neurological complications and mortality. Microvascular imaging (MVI) is an advanced Doppler technique that allows high-resolution visualization of microvasculature in the brain. We describe the feasibility and utility of MVI for the evaluation of cerebral microvascular perfusion in patients undergoing ECMO. Methods: We retrospectively analyzed brain MVI scans of neonates undergoing ECMO. Two pediatric radiologists qualitatively assessed MVI scans to determine the presence or absence of tortuosity, symmetry, heterogeneity, engorgement, and hypoperfusion of the basal ganglia–thalamus (BGT) region, as well as the presence or absence of white matter vascular engorgement and increased peri-gyral flow in the cortex. We tested the association between the presence of the aforementioned brain MVI features and clinical outcomes. Results: We included 30 patients, 14 of which were male (46.7%). The time of ECMO duration was 11.8 ± 6.9 days. The most prevalent microvascular finding in BGT was lenticulostriate vessel tortuosity (26/30, 86.7%), and the most common microvascular finding in the cortex was increased peri-gyral flow (10/24, 41.7%). Cortical white matter vascular engorgement was significantly associated with the presence of any poor outcome as defined by death, seizure, and/or cerebrovascular events on magnetic resonance imaging (p = 0.03). Conclusion: MVI is a feasible modality to evaluate cerebral perfusion in infants undergoing ECMO. Additionally, evidence of white matter vascular engorgement after ECMO cannulation could serve as a predictor of poor outcomes in this population.

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Section: Discussionmentioning

confidence: 99%

Utility of Cerebral Microvascular Imaging in Infants Undergoing ECMO

et al. 2022

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“…Intracranial hemorrhage is most happened in an infant during the rst 24 hours of life with a low level of Apgar store, in infants, who cannot cry especially among preterm newborns with respiratory distress syndrome (23). Cerebral blood ow is a predictive biomarker in neonatal hypoxic-ischemic injury (24).…”

Section: Discussionmentioning

confidence: 99%

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

Ijabi

Tehranian

Afrisham

et al. 2022

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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.

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“…Ultrasonography, MR Spectroscopy or MR angiography, having no risk of exposure to radiation, were the preferred modality. [38][39][40] . (Groenendaal 2016, Aida 2021,O Tierradentro-García 2021)…”

Section: Discussionmentioning

confidence: 99%

Molecular Imaging (PET and SPECT) for Children with Hypoxic-ischemic-encephalopathy and Cerebral Palsy before and after cell therapy.

Nakatake

Nabetani

Yutaka

et al. 2022

Preprint

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Glucose metabolism has been the focus of research in order to understand pathological conditions associated with diseases such as neonatal hypoxic-ischemic-encephalopathy (HIE), cerebral palsy (CP) and cerebral infarction.[Objective] To evaluate the use of molecular imaging (SPECT and PET) for children with HIE and CP before and after cell therapy, and to propose future perspectives on the use of those modalities for assessment of brain function in children with these conditions.[Methods] PubMed search for studies using PET or SPECT scans for HIE and CP in children.[Results] We identified 18 PET and 17 SPECT studies that have been performed in cases under age of 19 over the past three decades (1991–2021). Six papers on PET use consisted of one with human umbilical cord derived mesenchymal stromal cells, one mobilized peripheral blood mononuclear cells, three autologous bone marrow mononuclear cells and one allogeneic umbilical cord blood. 4/6 papers reported that PET-CT scan revealed increased glucose metabolism and 1/6 showed no significant change in glucose metabolism after cell therapy. One article on SPECT reported that 2/5 cases had improvement of cerebral perfusion in the thalamus after treatment.[Discussion] SPECT in the first few weeks of life is useful and more sensitive than MRI in predicting major neurological disability. SPECT is not appropriate for neonates because of the risk of radiation, improvement of other clinical test equipment. PET studies reported high glucose metabolism in the early neonatal periods in children with mild to moderate HIE, but not in the most severe cases, including those neonates that died.We suggested that PET could be more useful tool to estimate effectiveness of stem cell therapy than SPECT.[Conclusion] PET might be a good clinical modalities to clarify mechanism of stem cell therapy for CP. We need further clinical studies to clarify more precisely.

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Cerebral Blood Flow of the Neonatal Brain after Hypoxic–Ischemic Injury

Cited by 12 publications

References 145 publications

Utility of Cerebral Microvascular Imaging in Infants Undergoing ECMO

Utility of Cerebral Microvascular Imaging in Infants Undergoing ECMO

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

Molecular Imaging (PET and SPECT) for Children with Hypoxic-ischemic-encephalopathy and Cerebral Palsy before and after cell therapy.

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