title: Impaired cerebral autoregulation and brain injury in newborns with hypoxic-ischemic encephalopathy treated with hypothermia.
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.
authors.affiliation: 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.
authors.forename: An N
authors.initials: AN
authors.lastname: Massaro
authors.affiliation: 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.
authors.forename: R B
authors.initials: RB
authors.lastname: Govindan
authors.affiliation: 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.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Vezina
authors.affiliation: 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.
authors.forename: Taeun
authors.initials: T
authors.lastname: Chang
authors.affiliation: 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.
authors.forename: Nickie N
authors.initials: NN
authors.lastname: Andescavage
authors.affiliation: 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.
authors.forename: Yunfei
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Division of Fetal and Transitional Medicine, Children's National Health System, Washington, District of Columbia;
authors.forename: Tareq
authors.initials: T
authors.lastname: Al-Shargabi
authors.affiliation: Division of Fetal and Transitional Medicine, Children's National Health System, Washington, District of Columbia;
authors.forename: Marina
authors.initials: M
authors.lastname: Metzler
authors.affiliation: Department of Neurology, Children's National Health System, Washington, District of Columbia;
authors.forename: Kari
authors.initials: K
authors.lastname: Harris
authors.affiliation: 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.
authors.forename: Adre J
authors.initials: AJ
authors.lastname: du Plessis
mesh_terms: D001794:Blood Pressure; D001921:Brain / Q000473:pathology / Q000503:physiopathology*; D017679:Cryotherapy; D005260:Female; D007839:Functional Laterality; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000401:mortality / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy*; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D019265:Spectroscopy, Near-Infrared
keywords: cerebral blood flow; hypoxic-ischemic encephalopathy; magnetic resonance imaging; newborn