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

Author:

Massaro An N.123,Govindan R. B.23,Vezina Gilbert43,Chang Taeun53,Andescavage Nickie N.13,Wang Yunfei63,Al-Shargabi Tareq2,Metzler Marina2,Harris Kari5,du Plessis Adre J.23

Affiliation:

1. Division of Neonatology, Children's National Health System, Washington, District of Columbia;

2. Division of Fetal and Transitional Medicine, Children's National Health System, Washington, District of Columbia;

3. Department of Pediatrics, The George Washington University School of Medicine, Washington, District of Columbia

4. Division of Diagnostic Imaging and Radiology, Children's National Health System, Washington, District of Columbia;

5. Department of Neurology, Children's National Health System, Washington, District of Columbia;

6. Department of Biostatistics and Study Methodology, Children's National Health System, Washington, District of Columbia; and

Abstract

Impaired cerebral autoregulation may contribute to secondary injury in newborns with hypoxic-ischemic encephalopathy (HIE). Continuous, noninvasive assessment of cerebral pressure autoregulation can be achieved with bedside near-infrared spectroscopy (NIRS) and systemic mean arterial blood pressure (MAP) monitoring. This study aimed to evaluate whether impaired cerebral autoregulation measured by NIRS-MAP monitoring during therapeutic hypothermia and rewarming relates to outcome in 36 newborns with HIE. Spectral coherence analysis between NIRS and MAP was used to quantify changes in the duration [pressure passivity index (PPI)] and magnitude (gain) of cerebral autoregulatory impairment. Higher PPI in both cerebral hemispheres and gain in the right hemisphere were associated with neonatal adverse outcomes [death or detectable brain injury by magnetic resonance imaging (MRI), P < 0.001]. NIRS-MAP monitoring of cerebral autoregulation can provide an ongoing physiological biomarker that may help direct care in perinatal brain injury.

Funder

HHS | NIH | National Center for Advancing Translational Sciences (NCATS)

HHS | NIH | National Institute of Neurological Disorders and Stroke (NINDS)

Publisher

American Physiological Society

Subject

Physiology,General Neuroscience

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