title: Apparent diffusion coefficient scalars correlate with near-infrared spectroscopy markers of cerebrovascular autoregulation in neonates cooled for perinatal hypoxic-ischemic injury.
abstract: OBJECTIVE
  Neurologic morbidity remains high in neonates with perinatal hypoxic-ischemic injury despite therapeutic hypothermia. DTI provides qualitative and quantitative information about the microstructure of the brain, and a near-infrared spectroscopy index can assess cerebrovascular autoregulation. We hypothesized that lower ADC values would correlate with worse autoregulatory function.
  
  
  METHODS
  Thirty-one neonates with hypoxic-ischemic injury were enrolled. ADC scalars were measured in 27 neonates (age range, 4-15 days) in the anterior and posterior centrum semiovale, basal ganglia, thalamus, posterior limb of the internal capsule, pons, and middle cerebellar peduncle on MRI obtained after completion of therapeutic hypothermia. The blood pressure range of each neonate with the most robust autoregulation was identified by using a near-infrared spectroscopy index. Autoregulatory function was measured by blood pressure deviation below the range with optimal autoregulation.
  
  
  RESULTS
  In neonates who had MRI on day of life ≥10, lower ADC scalars in the posterior centrum semiovale (r = -0.87, P = .003, n = 9) and the posterior limb of the internal capsule (r = -0.68, P = .04, n = 9) correlated with blood pressure deviation below the range with optimal autoregulation during hypothermia. Lower ADC scalars in the basal ganglia correlated with worse autoregulation during rewarming (r = -0.71, P = .05, n = 8).
  
  
  CONCLUSIONS
  Blood pressure deviation from the optimal autoregulatory range may be an early biomarker of injury in the posterior centrum semiovale, posterior limb of the internal capsule, and basal ganglia. Optimizing blood pressure to support autoregulation may decrease the risk of brain injury in cooled neonates with hypoxic-ischemic injury.
authors.affiliation: From the Division of Pediatric Radiology and Pediatric Neuroradiology (A.T., A.P., M.M.S., T.A.G.M.H., E.A.), Department of Radiology Neurosciences Intensive Care Nursery Program (A.T., A.P., T.A.G.M.H, J.A.H., C.P., K.S., M.M.G., F.J.N., J.K.L.) atekes1@jhmi.edu.
authors.forename: A
authors.initials: A
authors.lastname: Tekes
authors.affiliation: From the Division of Pediatric Radiology and Pediatric Neuroradiology (A.T., A.P., M.M.S., T.A.G.M.H., E.A.), Department of Radiology Neurosciences Intensive Care Nursery Program (A.T., A.P., T.A.G.M.H, J.A.H., C.P., K.S., M.M.G., F.J.N., J.K.L.).
authors.forename: A
authors.initials: A
authors.lastname: Poretti
authors.affiliation: From the Division of Pediatric Radiology and Pediatric Neuroradiology (A.T., A.P., M.M.S., T.A.G.M.H., E.A.), Department of Radiology.
authors.forename: M M
authors.initials: MM
authors.lastname: Scheurkogel
authors.affiliation: From the Division of Pediatric Radiology and Pediatric Neuroradiology (A.T., A.P., M.M.S., T.A.G.M.H., E.A.), Department of Radiology Neurosciences Intensive Care Nursery Program (A.T., A.P., T.A.G.M.H, J.A.H., C.P., K.S., M.M.G., F.J.N., J.K.L.).
authors.forename: T A G M
authors.initials: TA
authors.lastname: Huisman
authors.affiliation: Neurosciences Intensive Care Nursery Program (A.T., A.P., T.A.G.M.H, J.A.H., C.P., K.S., M.M.G., F.J.N., J.K.L.) Division of Neonatology, (J.A.H., C.P., K.S., M.M.G., F.J.N.), Department of Pediatrics.
authors.forename: J A
authors.initials: JA
authors.lastname: Howlett
authors.affiliation: From the Division of Pediatric Radiology and Pediatric Neuroradiology (A.T., A.P., M.M.S., T.A.G.M.H., E.A.), Department of Radiology.
authors.forename: E
authors.initials: E
authors.lastname: Alqahtani
authors.affiliation: Department of Anesthesiology and Critical Care Medicine (J.-H.L., C.W.H., R.C.K.).
authors.forename: J-H
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Neurosciences Intensive Care Nursery Program (A.T., A.P., T.A.G.M.H, J.A.H., C.P., K.S., M.M.G., F.J.N., J.K.L.) Division of Neonatology, (J.A.H., C.P., K.S., M.M.G., F.J.N.), Department of Pediatrics.
authors.forename: C
authors.initials: C
authors.lastname: Parkinson
authors.affiliation: Neurosciences Intensive Care Nursery Program (A.T., A.P., T.A.G.M.H, J.A.H., C.P., K.S., M.M.G., F.J.N., J.K.L.) Division of Neonatology, (J.A.H., C.P., K.S., M.M.G., F.J.N.), Department of Pediatrics.
authors.forename: K
authors.initials: K
authors.lastname: Shapiro
authors.affiliation: Division of General Pediatrics and Adolescent Medicine (S.-E.C., J.M.J.), Department of Pediatrics Center for Child and Community Health Research (S.-E.C., J.M.J., J.K.L.).
authors.forename: S-E
authors.initials: SE
authors.lastname: Chung
authors.affiliation: Division of General Pediatrics and Adolescent Medicine (S.-E.C., J.M.J.), Department of Pediatrics Center for Child and Community Health Research (S.-E.C., J.M.J., J.K.L.).
authors.forename: J M
authors.initials: JM
authors.lastname: Jennings
authors.affiliation: Neurosciences Intensive Care Nursery Program (A.T., A.P., T.A.G.M.H, J.A.H., C.P., K.S., M.M.G., F.J.N., J.K.L.) Division of Neonatology, (J.A.H., C.P., K.S., M.M.G., F.J.N.), Department of Pediatrics.
authors.forename: M M
authors.initials: MM
authors.lastname: Gilmore
authors.affiliation: Department of Anesthesiology and Critical Care Medicine (J.-H.L., C.W.H., R.C.K.).
authors.forename: C W
authors.initials: CW
authors.lastname: Hogue
authors.affiliation: Division of Neuropathology (L.J.M.), Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: L J
authors.initials: LJ
authors.lastname: Martin
authors.affiliation: Department of Anesthesiology and Critical Care Medicine (J.-H.L., C.W.H., R.C.K.).
authors.forename: R C
authors.initials: RC
authors.lastname: Koehler
authors.affiliation: Neurosciences Intensive Care Nursery Program (A.T., A.P., T.A.G.M.H, J.A.H., C.P., K.S., M.M.G., F.J.N., J.K.L.) Division of Neonatology, (J.A.H., C.P., K.S., M.M.G., F.J.N.), Department of Pediatrics.
authors.forename: F J
authors.initials: FJ
authors.lastname: Northington
authors.affiliation: Neurosciences Intensive Care Nursery Program (A.T., A.P., T.A.G.M.H, J.A.H., C.P., K.S., M.M.G., F.J.N., J.K.L.) Center for Child and Community Health Research (S.-E.C., J.M.J., J.K.L.).
authors.forename: J K
authors.initials: JK
authors.lastname: Lee
mesh_terms: D001794:Blood Pressure; D001921:Brain / Q000503:physiopathology; D001930:Brain Injuries / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control; D002560:Cerebrovascular Circulation / Q000502:physiology; D005260:Female; D006706:Homeostasis / Q000502:physiology*; D006801:Humans; D007036:Hypothermia, Induced; D020925:Hypoxia-Ischemia, Brain / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D019265:Spectroscopy, Near-Infrared