Cerebrovascular autoregulation and neurologic injury in neonatal hypoxic-ischemic encephalopathy
| Autor: | Jessica J. Jamrogowicz, Aylin Tekes, Jessica A. Howlett, Jennifer K. Lee, Shang En Chung, Jacky M. Jennings, Frances J. Northington, Eric M. Jackson, Kenneth Martin Brady, Christoph U. Lehmann, Raymond C. Koehler, Charlamaine Parkinson, Abby C. Larson, Maureen M. Gilmore, Thierry A.G.M. Huisman |
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| Jazyk: | angličtina |
| Rok vydání: | 2013 |
| Předmět: |
Encephalopathy
Article White matter 03 medical and health sciences Hemoglobins 0302 clinical medicine 030225 pediatrics Basal ganglia medicine Homeostasis Humans Autoregulation Arterial Pressure Oximetry Spectroscopy Near-Infrared medicine.diagnostic_test business.industry Infant Newborn Brain Magnetic resonance imaging Hypothermia medicine.disease Magnetic Resonance Imaging 3. Good health medicine.anatomical_structure Blood pressure Cerebral blood flow nervous system Anesthesia Cerebrovascular Circulation Pediatrics Perinatology and Child Health Hypoxia-Ischemia Brain medicine.symptom business 030217 neurology & neurosurgery |
| Zdroj: | Pediatric research |
| ISSN: | 1530-0447 0031-3998 |
| Popis: | Background Neonates with hypoxic-ischemic encephalopathy (HIE) are at risk of cerebral blood flow dysregulation. Our objective was to describe the relationship between autoregulation and neurologic injury in HIE. Methods Neonates with HIE had autoregulation monitoring with the hemoglobin volume index (HVx) during therapeutic hypothermia, rewarming, and the first 6 h of normothermia. The 5-mmHg range of mean arterial blood pressure (MAP) with best vasoreactivity (MAPOPT) was identified. The percentage of time spent with MAP below MAPOPT and deviation in MAP from MAPOPT were measured. Neonates received brain MRIs 3–7 days after treatment. MRIs were coded as no, mild, or moderate/severe injury in five regions. Results HVx identified MAPOPT in 79% (19/24), 77% (17/22), and 86% (18/21) of neonates during hypothermia, rewarming, and normothermia, respectively. Neonates with moderate/severe injury in paracentral gyri, white matter, basal ganglia, and thalamus spent a greater proportion of time with MAP below MAPOPT during rewarming than neonates with no or mild injury. Neonates with moderate/severe injury in paracentral gyri, basal ganglia, and thalamus had greater MAP deviation below MAPOPT during rewarming than neonates without injury. Conclusion Maintaining MAP within or above MAPOPT may reduce the risk of neurologic injuries in neonatal HIE. |
| Databáze: | OpenAIRE |
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