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

An N Massaro; R B Govindan; Gilbert Vezina; Taeun Chang; Nickie N Andescavage; Yunfei Wang; Tareq Al-Shargabi; Marina Metzler; Kari Harris; Adre J du Plessis

doi:10.1152/jn.00353.2015

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

J Neurophysiol. 2015 Aug;114(2):818-24. doi: 10.1152/jn.00353.2015. Epub 2015 Jun 10.

Authors

Affiliations

¹ Division of Neonatology, Children's National Health System, Washington, District of Columbia; Division of Fetal and Transitional Medicine, Children's National Health System, Washington, District of Columbia; Department of Pediatrics, The George Washington University School of Medicine, Washington, District of Columbia anguyenm@childrensnational.org.
² Division of Fetal and Transitional Medicine, Children's National Health System, Washington, District of Columbia; Department of Pediatrics, The George Washington University School of Medicine, Washington, District of Columbia.
³ Division of Diagnostic Imaging and Radiology, Children's National Health System, Washington, District of Columbia; Department of Pediatrics, The George Washington University School of Medicine, Washington, District of Columbia.
⁴ Department of Neurology, Children's National Health System, Washington, District of Columbia; Department of Pediatrics, The George Washington University School of Medicine, Washington, District of Columbia.
⁵ Division of Neonatology, Children's National Health System, Washington, District of Columbia; Department of Pediatrics, The George Washington University School of Medicine, Washington, District of Columbia.
⁶ Department of Biostatistics and Study Methodology, Children's National Health System, Washington, District of Columbia; and Department of Pediatrics, The George Washington University School of Medicine, Washington, District of Columbia.
⁷ Division of Fetal and Transitional Medicine, Children's National Health System, Washington, District of Columbia;
⁸ Department of Neurology, Children's National Health System, Washington, District of Columbia;

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.

Keywords: cerebral blood flow; hypoxic-ischemic encephalopathy; magnetic resonance imaging; newborn.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Blood Pressure
Brain / pathology
Brain / physiopathology*
Cryotherapy*
Female
Functional Laterality
Humans
Hypoxia-Ischemia, Brain / mortality
Hypoxia-Ischemia, Brain / pathology
Hypoxia-Ischemia, Brain / physiopathology*
Hypoxia-Ischemia, Brain / therapy*
Infant, Newborn
Magnetic Resonance Imaging
Male
Prospective Studies
Spectroscopy, Near-Infrared

Abstract

Publication types

MeSH terms

Grants and funding