title: Sex-specific associations between cerebrovascular blood pressure autoregulation and cardiopulmonary injury in neonatal encephalopathy and therapeutic hypothermia.
abstract: BACKGROUND
  Cardiopulmonary injury is common in neonatal encephalopathy, but the link with cerebrovascular dysfunction is unknown. We hypothesized that alterations of cerebral autoregulation are associated with cardiopulmonary injury in neonates treated with therapeutic hypothermia (TH) for neonatal encephalopathy.
  
  
  METHODS
  The cerebral hemoglobin volume index (HVx) from near-infrared spectroscopy was used to identify the mean arterial blood pressure (MAP) with optimal autoregulatory vasoreactivity (MAPOPT). We measured associations between MAP relative to MAPOPTand indicators of cardiopulmonary injury (duration of mechanical respiratory support and administration of inhaled nitric oxide (iNO), milrinone, or steroids).
  
  
  RESULTS
  We identified associations between cerebrovascular autoregulation and cardiopulmonary injury that were often sex-specific. Greater MAP deviation above MAPOPTwas associated with shorter duration of intubation in boys but longer ventilatory support in girls. Greater MAP deviation below MAPOPTrelated to longer intensive care stay in boys. Milrinone was associated with greater MAP deviation below MAPOPTin girls.
  
  
  CONCLUSIONS
  MAP deviation from MAPOPTmay relate to cardiopulmonary injury after neonatal encephalopathy, and sex may modulate this relationship. Whereas MAP above MAPOPTmay protect the brain and lungs in boys, it may be related to cardiopulmonary injury in girls. Future studies are needed to characterize the role of sex in these associations.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland.|Neurosciences Intensive Care Nursery, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Raul
authors.initials: R
authors.lastname: Chavez-Valdez
authors.affiliation: Division of Neonatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Matthew
authors.initials: M
authors.lastname: O'Connor
authors.affiliation: Department of Pediatrics, Center for Child and Community Health Research (CCHR), Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Jamie
authors.initials: J
authors.lastname: Perin
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Michael
authors.initials: M
authors.lastname: Reyes
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Jillian
authors.initials: J
authors.lastname: Armstrong
authors.affiliation: Neurosciences Intensive Care Nursery, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Charlamaine
authors.initials: C
authors.lastname: Parkinson
authors.affiliation: Division of Neonatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Maureen
authors.initials: M
authors.lastname: Gilmore
authors.affiliation: Department of Pediatrics, Center for Child and Community Health Research (CCHR), Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Jacky
authors.initials: J
authors.lastname: Jennings
authors.affiliation: Division of Neonatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland.|Neurosciences Intensive Care Nursery, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Frances J
authors.initials: FJ
authors.lastname: Northington
authors.affiliation: Neurosciences Intensive Care Nursery, Johns Hopkins School of Medicine, Baltimore, Maryland.|Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Lee
mesh_terms: D000280:Administration, Inhalation; D062186:Arterial Pressure; D015415:Biomarkers / Q000097:blood; D001927:Brain Diseases / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D002560:Cerebrovascular Circulation; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006454:Hemoglobins / Q000378:metabolism; D006706:Homeostasis; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects; D007231:Infant, Newborn; D008171:Lung Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D020105:Milrinone / Q000008:administration & dosage; D009569:Nitric Oxide / Q000008:administration & dosage; D012121:Respiration, Artificial; D012307:Risk Factors; D012737:Sex Factors; D019265:Spectroscopy, Near-Infrared; D013256:Steroids / Q000008:administration & dosage; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D013256:Steroids; D014665:Vasodilator Agents; D009569:Nitric Oxide; D020105:Milrinone