Relationships between cerebral autoregulation and markers of kidney and liver injury in neonatal encephalopathy and therapeutic hypothermia

Lee, J K; Perin, Jamie; Parkinson, C; O’Connor, Matthew; Gilmore, Maureen; Reyes, Michael; Armstrong, James C.; Jennings, Jacky M.; Northington, Frances J.; Chavez‐Valdez, Raul

doi:10.1038/jp.2017.64

Cited by 13 publications

(13 citation statements)

References 21 publications

(54 reference statements)

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“…76–78,80,85,86 Blood pressure deviation from optimal ABP delineated in this way may also be associated with cardiopulmonary and renal injury in neonatal HIE and renal injury after cardiopulmonary bypass. 31–33…”

Section: Methods To Measure Neonatal Autoregulationmentioning

confidence: 99%

Neonatal cerebrovascular autoregulation

et al. 2018

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Cerebrovascular pressure autoregulation is the physiologic mechanism that holds cerebral blood flow (CBF) relatively constant across changes in cerebral perfusion pressure (CPP). Cerebral vasoreactivity refers to the vasoconstriction and vasodilation that occur during fluctuations in arterial blood pressure (ABP) to maintain autoregulation. These are vital protective mechanisms of the brain. Impairments in pressure autoregulation increase the risk of brain injury and persistent neurologic disability. Autoregulation may be impaired during various neonatal disease states including prematurity, hypoxic-ischemic encephalopathy (HIE), intraventricular hemorrhage, congenital cardiac disease, and infants requiring extracorporeal membrane oxygenation (ECMO). Because infants are exquisitely sensitive to changes in cerebral blood flow (CBF), both hypoperfusion and hyperperfusion can cause significant neurologic injury. We will review neonatal pressure autoregulation and autoregulation monitoring techniques with a focus on brain protection. Current clinical therapies have failed to fully prevent permanent brain injuries in neonates. Adjuvant treatments that support and optimize autoregulation may improve neurologic outcomes.

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Section: Methods To Measure Neonatal Autoregulationmentioning

confidence: 99%

Neonatal cerebrovascular autoregulation

et al. 2018

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“…After that, NIRS became standard clinical care for HIE in our NICU, and the IRB waived the requirement for written consent. Sixty-six neonates in this study were reported in at least one of our past reports ( 4 – 7 , 15 – 18 ). Four neonates contributed new data to the study.…”

Section: Methodsmentioning

confidence: 91%

“…This is a secondary and exploratory analysis of data from our prior studies (4)(5)(6)(7)(15)(16)(17)(18). No other studies have calculated MAPopt using wavelet or multi-window autoregulation monitoring in HIE to our knowledge.…”

Section: Sample Size Estimationmentioning

confidence: 99%

Wavelet Autoregulation Monitoring Identifies Blood Pressures Associated With Brain Injury in Neonatal Hypoxic-Ischemic Encephalopathy

et al. 2021

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Dysfunctional cerebrovascular autoregulation may contribute to neurologic injury in neonatal hypoxic-ischemic encephalopathy (HIE). Identifying the optimal mean arterial blood pressure (MAPopt) that best supports autoregulation could help identify hemodynamic goals that support neurologic recovery. In neonates who received therapeutic hypothermia for HIE, we hypothesized that the wavelet hemoglobin volume index (wHVx) would identify MAPopt and that blood pressures closer to MAPopt would be associated with less brain injury on MRI. We also tested a correlation-derived hemoglobin volume index (HVx) and single- and multi-window data processing methodology. Autoregulation was monitored in consecutive 3-h periods using near infrared spectroscopy in an observational study. The neonates had a mean MAP of 54 mmHg (standard deviation: 9) during hypothermia. Greater blood pressure above the MAPopt from single-window wHVx was associated with less injury in the paracentral gyri (p = 0.044; n = 63), basal ganglia (p = 0.015), thalamus (p = 0.013), and brainstem (p = 0.041) after adjustments for sex, vasopressor use, seizures, arterial carbon dioxide level, and a perinatal insult score. Blood pressure exceeding MAPopt from the multi-window, correlation HVx was associated with less injury in the brainstem (p = 0.021) but not in other brain regions. We conclude that applying wavelet methodology to short autoregulation monitoring periods may improve the identification of MAPopt values that are associated with brain injury. Having blood pressure above MAPopt with an upper MAP of ~50–60 mmHg may reduce the risk of brain injury during therapeutic hypothermia. Though a cause-and-effect relationship cannot be inferred, the data support the need for randomized studies of autoregulation and brain injury in neonates with HIE.

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“…( 10 , 13 ) All neonates in the current study were also reported in our past autoregulation studies. ( 10 – 13 , 17 , 19 – 20 )…”

Section: Methodsmentioning

confidence: 99%

Later cooling within 6 h and temperatures outside 33–34 °C are not associated with dysfunctional autoregulation during hypothermia for neonatal encephalopathy

Gilmore

Tekes²,

Perin

et al. 2020

Pediatr Res

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Background: Cooling delays, temperature outside 33–34°C, and blood pressure below the mean arterial blood pressure with optimal cerebral autoregulation (MAP OPT ) might diminish neuroprotection from therapeutic hypothermia in neonates with hypoxic-ischemic encephalopathy (HIE). We hypothesized that longer time to reach temperature <34°C and having temperature outside 33–34°C would be associated with worse autoregulation and greater brain injury. Methods: Neonates with HIE had rectal temperature and near-infrared spectroscopy autoregulation monitoring during hypothermia (n=63) and rewarming (n=58). All underwent brain MRI, and a subset received diffusion tensor imaging MRI before day 10 (n=41). Results: Most neonates reached <34°C at 3–6 h of life. MAP OPT was identified in 54/63 (86%) during hypothermia and in 53/58 (91%) during rewarming. Cooling time was not related to blood pressure deviation from MAP OPT . Later cooling was associated with lower ADC scalar in unilateral posterior centrum semiovale but not in other regions. Temperatures above 34°C were associated with blood pressure above MAP OPT but not with brain injury. Conclusion: In neonates who were predominantly cooled after 3 h, cooling time was not associated with autoregulation or overall brain injury. Blood pressure deviation above MAP OPT was associated with temperature above 34°C. Additional studies are needed in a more heterogeneous population.

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Relationships between cerebral autoregulation and markers of kidney and liver injury in neonatal encephalopathy and therapeutic hypothermia

Cited by 13 publications

References 21 publications

Neonatal cerebrovascular autoregulation

Neonatal cerebrovascular autoregulation

Wavelet Autoregulation Monitoring Identifies Blood Pressures Associated With Brain Injury in Neonatal Hypoxic-Ischemic Encephalopathy

Later cooling within 6 h and temperatures outside 33–34 °C are not associated with dysfunctional autoregulation during hypothermia for neonatal encephalopathy

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