Early predictors of short term neurodevelopmental outcome in asphyxiated cooled infants. A combined brain amplitude integrated electroencephalography and near infrared spectroscopy study

Ancora, Gina; Maranella, Eugenia; Grandi, Sara; Sbravati, Francesca; Coccolini, Elena; Savini, Silvia; Faldella, Giacomo

doi:10.1016/j.braindev.2011.09.008

Cited by 89 publications

(92 citation statements)

References 28 publications

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“…In a recent study of neonates with HIE who underwent TH, rSO 2 was reported as slightly higher in HIE with adverse outcomes at 6, 12, and 24 hours of life compared with neonates with good outcomes; however the difference was only significant at 12 hours. 48 In the current study, SO 2 in neonates with HIE was higher than post-TH, but the difference was not significant. With an elevation of SO 2 occurring both with and without TH, SO 2 alone appears to be less sensitive to the therapy and metabolic disturbances occurring in the first few days after birth.…”

Section: Indices Of Cerebral Oxygen Metabolism and Cerebral Blood Flowmentioning

confidence: 72%

Cerebral Oxygen Metabolism in Neonatal Hypoxic Ischemic Encephalopathy during and after Therapeutic Hypothermia

Dehaes

Aggarwal

Lin

et al. 2013

J Cereb Blood Flow Metab

105

121

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Pathophysiologic mechanisms involved in neonatal hypoxic ischemic encephalopathy (HIE) are associated with complex changes of blood flow and metabolism. Therapeutic hypothermia (TH) is effective in reducing the extent of brain injury, but it remains uncertain how TH affects cerebral blood flow (CBF) and metabolism. Ten neonates undergoing TH for HIE and seventeen healthy controls were recruited from the NICU and the well baby nursery, respectively. A combination of frequency domain near infrared spectroscopy (FDNIRS) and diffuse correlation spectroscopy (DCS) systems was used to non-invasively measure cerebral hemodynamic and metabolic variables at the bedside. Results showed that cerebral oxygen metabolism (CMRO 2i ) and CBF indices (CBF i ) in neonates with HIE during TH were significantly lower than post-TH and age-matched control values. Also, cerebral blood volume (CBV) and hemoglobin oxygen saturation (SO 2 ) were significantly higher in neonates with HIE during TH compared with age-matched control neonates. Post-TH CBV was significantly decreased compared with values during TH whereas SO 2 remained unchanged after the therapy. Thus, FDNIRS-DCS can provide information complimentary to SO 2 and can assess individual cerebral metabolic responses to TH. Combined FDNIRS-DCS parameters improve the understanding of the underlying physiology and have the potential to serve as bedside biomarkers of treatment response and optimization. Keywords: cerebral blood circulation; cerebral hemoglobin oxygen saturation; cerebral metabolic rate of oxygen consumption; near infrared spectroscopy; neonatal hypoxic ischemic encephalopathy; therapeutic hypothermia INTRODUCTION Neonatal hypoxic ischemic encephalopathy (HIE) occurs in B2 to 3 per 1,000 live births in the USA, with devastating consequences including neurodevelopmental disabilities such as cerebral palsy, life-long cognitive impairment, and epilepsy.1 In HIE, there is a period of reduced blood flow (ischemia) and oxygen delivery (hypoxia) followed by reperfusion with transient energy recovery, and then a secondary energy failure.2 Treatment is aimed at preventing the cascade of events that begin with reperfusion and lead to secondary energy failure and inevitable cell death; this is the 'window of opportunity.' 3 Theories for injury mechanisms in this window suggest a central role for excitotoxicity and oxidative stress with the injury evolving over hours to weeks.2 Therapeutic hypothermia (TH) is the treatment of choice for HIE, as it is the only treatment with proven efficacy and acts through a variety of mechanisms, including those associated with decreased neuronal energy metabolism. 4 Although early studies showed that TH decreased rates of both mortality and disability, recently published long-term outcomes have demonstrated significance only for decreased mortality rates.5 In addition, a recent

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Section: Indices Of Cerebral Oxygen Metabolism and Cerebral Blood Flowmentioning

confidence: 72%

Cerebral Oxygen Metabolism in Neonatal Hypoxic Ischemic Encephalopathy during and after Therapeutic Hypothermia

Dehaes

Aggarwal

Lin

et al. 2013

J Cereb Blood Flow Metab

105

121

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“…More recently, NIRS has emerged as an alternative method to interrogate CBF continuously and noninvasively at the bedside (Edwards et al 1988;Skov et al 1991). While prior studies have linked NIRS measures with outcomes in HIE (Ancora et al 2013;Lemmers et al 2013;Meek et al 1999;Toet et al 2006;van Bel et al 1993;Zaramella et al 2007), few studies have focused on evaluating the relationship between MAP and NIRS as a method to interrogate autoregulation (Howlett et al 2013;Tekes et al 2015). Signs of impaired cerebral pressure autoregulation may precede the presence of unregulated CBF, giving this approach the potential advantage of directing intervention before irreversible injury has occurred.…”

Section: Discussionmentioning

confidence: 99%

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

Massaro

Govindan

Vézina

et al. 2015

Journal of Neurophysiology

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“…There are limited and conflicting data showing that this is also the case during hypothermia (15)(16)(17).…”

mentioning

confidence: 99%

Cerebral oxygenation and brain activity after perinatal asphyxia: does hypothermia change their prognostic value?

et al. 2013

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Background:Hypothermia is an established therapy in term neonates to reduce death and disability after perinatal asphyxia. Near-infrared spectroscopy-monitored regional cerebral oxygen saturation (rScO 2 ) and amplitude-integrated electroencephalogram (aEEG)-monitored background pattern have been shown to be early predictors of long-term neurodevelopmental outcome. The aim of this study was to investigate the prognostic value of rScO 2 and aEEG for neurodevelopmental outcome in neonates with hypoxic-ischemic encephalopathy (HIE) treated with hypothermia. Methods: In neonates with HIE who were subjected to hypothermia, the aEEG background pattern and rScO 2 were studied prospectively from admission up to 84 h in relation to early magnetic resonance imaging and neurodevelopmental outcome at 18 mo of age. results: Of 39 infants, 12 neonates died because of neurological deterioration. One had an adverse outcome and 26 had a favorable outcome. The rScO 2 was higher in neonates with adverse outcome, although aEEG scores were lower. Positive predictive values at 12, 24, and 36 h of age for adverse outcome ranged from 50 to 67% for rScO 2 and aEEG; negative predictive values ranged from 73 to 96% for rScO 2 and 90 to 100% for aEEG. Combining rScO 2 and aEEG increased positive predictive values (70-91%) and negative predictive values (90-100%). conclusion: During hypothermia, rScO 2 and aEEG measurements are early predictors of long-term outcome after HIE. Combining both parameters further improves early prediction.

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Early predictors of short term neurodevelopmental outcome in asphyxiated cooled infants. A combined brain amplitude integrated electroencephalography and near infrared spectroscopy study

Cited by 89 publications

References 28 publications

Cerebral Oxygen Metabolism in Neonatal Hypoxic Ischemic Encephalopathy during and after Therapeutic Hypothermia

Cerebral Oxygen Metabolism in Neonatal Hypoxic Ischemic Encephalopathy during and after Therapeutic Hypothermia

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

Cerebral oxygenation and brain activity after perinatal asphyxia: does hypothermia change their prognostic value?

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