title: Optimizing Cerebral Autoregulation May Decrease Neonatal Regional Hypoxic-Ischemic Brain Injury.
abstract: Therapeutic hypothermia provides incomplete neuroprotection for neonatal hypoxic-ischemic encephalopathy (HIE). We examined whether hemodynamic goals that support autoregulation are associated with decreased brain injury and whether these relationships are affected by birth asphyxia or vary by anatomic region.
  
  
  
  Neonates cooled for HIE received near-infrared spectroscopy autoregulation monitoring to identify the mean arterial blood pressure with optimized autoregulatory function (MAPOPT). Blood pressure deviation from MAPOPT was correlated with brain injury on MRI after adjusting for the effects of arterial carbon dioxide, vasopressors, seizures, and birth asphyxia severity.
  
  
  
  Blood pressure deviation from MAPOPT related to neurologic injury in several regions independent of birth asphyxia severity. Greater duration and deviation of blood pressure below MAPOPT were associated with greater injury in the paracentral gyri and white matter. Blood pressure within MAPOPT related to lesser injury in the white matter, putamen and globus pallidus, and brain stem. Finally, blood pressures that exceeded MAPOPT were associated with reduced injury in the paracentral gyri.
  
  
  
  Blood pressure deviation from optimal autoregulatory vasoreactivity was associated with MRI markers of brain injury that, in many regions, were independent of the initial birth asphyxia. Targeting hemodynamic ranges to optimize autoregulation has potential as an adjunctive therapy to hypothermia for HIE.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Lee
authors.forename: Andrea
authors.initials: A
authors.lastname: Poretti
authors.forename: Jamie
authors.initials: J
authors.lastname: Perin
authors.forename: Thierry A G M
authors.initials: TAGM
authors.lastname: Huisman
authors.forename: Charlamaine
authors.initials: C
authors.lastname: Parkinson
authors.forename: Raul
authors.initials: R
authors.lastname: Chavez-Valdez
authors.forename: Matthew
authors.initials: M
authors.lastname: O'Connor
authors.forename: Michael
authors.initials: M
authors.lastname: Reyes
authors.forename: Jillian
authors.initials: J
authors.lastname: Armstrong
authors.forename: Jacky M
authors.initials: JM
authors.lastname: Jennings
authors.forename: Maureen M
authors.initials: MM
authors.lastname: Gilmore
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Koehler
authors.forename: Frances J
authors.initials: FJ
authors.lastname: Northington
authors.forename: Aylin
authors.initials: A
authors.lastname: Tekes
mesh_terms: D001238:Asphyxia Neonatorum / Q000150:complications / Q000503:physiopathology; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006706:Homeostasis / Q000502:physiology*; D006801:Humans; D007036:Hypothermia, Induced; D020925:Hypoxia-Ischemia, Brain / Q000209:etiology / Q000503:physiopathology*; D007231:Infant, Newborn; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D019265:Spectroscopy, Near-Infrared
keywords: Brain injury; Cerebral blood flow; Hypoxia; Hypoxic-ischemic encephalopathy; Neonates