Late failure of cerebral autoregulation in hypoxic-ischemic encephalopathy is associated with brain injury: a pilot study

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.

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S88. Classification for non-hypoxic ischemic encephalopathy based on standardized critical care EEG terminology: A pilot study

Clinical Neurophysiology ◽

10.1016/j.clinph.2018.04.448 ◽

2018 ◽

Vol 129 ◽

pp. e175

Author(s):

Neville M. Jadeja ◽

Henrikas Vaitkevicius ◽

Jong Lee

Keyword(s):

Critical Care ◽

Pilot Study ◽

Hypoxic Ischemic Encephalopathy ◽

Ischemic Encephalopathy

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Automated EEG background analysis to identify neonates with hypoxic-ischemic encephalopathy treated with hypothermia at risk for adverse outcome: A pilot study

Pediatrics & Neonatology ◽

10.1016/j.pedneo.2018.03.010 ◽

2019 ◽

Vol 60 (1) ◽

pp. 50-58 ◽

Cited By ~ 3

Author(s):

Anneleen Dereymaeker ◽

Vladimir Matic ◽

Jan Vervisch ◽

Perumpillichira J. Cherian ◽

Amir H. Ansari ◽

...

Keyword(s):

At Risk ◽

Pilot Study ◽

Adverse Outcome ◽

Hypoxic Ischemic Encephalopathy ◽

Ischemic Encephalopathy

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Serum Biomarkers of MRI Brain Injury in Neonatal Hypoxic Ischemic Encephalopathy Treated With Whole-Body Hypothermia

Pediatric Critical Care Medicine ◽

10.1097/pcc.0b013e3182720642 ◽

2013 ◽

Vol 14 (3) ◽

pp. 310-317 ◽

Cited By ~ 47

Author(s):

An N. Massaro ◽

Andreas Jeromin ◽

Nadja Kadom ◽

Gilbert Vezina ◽

Ronald L. Hayes ◽

...

Keyword(s):

Brain Injury ◽

Serum Biomarkers ◽

Hypoxic Ischemic Encephalopathy ◽

Whole Body ◽

Mri Brain ◽

Ischemic Encephalopathy

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Acute Perinatal Sentinel Events, Neonatal Brain Injury Pattern, and Outcome of Infants Undergoing a Trial of Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy

The Journal of Pediatrics ◽

10.1016/j.jpeds.2016.09.026 ◽

2017 ◽

Vol 180 ◽

pp. 275-278.e2 ◽

Cited By ~ 14

Author(s):

Seetha Shankaran ◽

Abbot R. Laptook ◽

Scott A. McDonald ◽

Susan R. Hintz ◽

Patrick D. Barnes ◽

...

Keyword(s):

Brain Injury ◽

Injury Pattern ◽

Hypoxic Ischemic Encephalopathy ◽

Neonatal Brain ◽

Neonatal Brain Injury ◽

Sentinel Events ◽

Ischemic Encephalopathy

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Wavelet Autoregulation Monitoring Identifies Blood Pressures Associated With Brain Injury in Neonatal Hypoxic-Ischemic Encephalopathy

Frontiers in Neurology ◽

10.3389/fneur.2021.662839 ◽

2021 ◽

Vol 12 ◽

Author(s):

Xiuyun Liu ◽

Aylin Tekes ◽

Jamie Perin ◽

May W. Chen ◽

Bruno P. Soares ◽

...

Keyword(s):

Blood Pressure ◽

Brain Injury ◽

Therapeutic Hypothermia ◽

Near Infrared ◽

Brain Regions ◽

Hypoxic Ischemic Encephalopathy ◽

Volume Index ◽

Arterial Blood ◽

Blood Pressures ◽

Ischemic Encephalopathy

Dysfunctional cerebrovascular autoregulation may contribute to neurologic injury in neonatal hypoxic-ischemic encephalopathy (HIE). Identifying the optimal mean arterial blood pressure (MAPopt) that best supports autoregulation could help identify hemodynamic goals that support neurologic recovery. In neonates who received therapeutic hypothermia for HIE, we hypothesized that the wavelet hemoglobin volume index (wHVx) would identify MAPopt and that blood pressures closer to MAPopt would be associated with less brain injury on MRI. We also tested a correlation-derived hemoglobin volume index (HVx) and single- and multi-window data processing methodology. Autoregulation was monitored in consecutive 3-h periods using near infrared spectroscopy in an observational study. The neonates had a mean MAP of 54 mmHg (standard deviation: 9) during hypothermia. Greater blood pressure above the MAPopt from single-window wHVx was associated with less injury in the paracentral gyri (p = 0.044; n = 63), basal ganglia (p = 0.015), thalamus (p = 0.013), and brainstem (p = 0.041) after adjustments for sex, vasopressor use, seizures, arterial carbon dioxide level, and a perinatal insult score. Blood pressure exceeding MAPopt from the multi-window, correlation HVx was associated with less injury in the brainstem (p = 0.021) but not in other brain regions. We conclude that applying wavelet methodology to short autoregulation monitoring periods may improve the identification of MAPopt values that are associated with brain injury. Having blood pressure above MAPopt with an upper MAP of ~50–60 mmHg may reduce the risk of brain injury during therapeutic hypothermia. Though a cause-and-effect relationship cannot be inferred, the data support the need for randomized studies of autoregulation and brain injury in neonates with HIE.

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Correlation Between White Matter Injury Identified by Neonatal Diffusion Tensor Imaging and Neurodevelopmental Outcomes Following Term Neonatal Asphyxia and Therapeutic Hypothermia: An Exploratory Pilot Study

Journal of Child Neurology ◽

10.1177/0883073819841717 ◽

2019 ◽

Vol 34 (10) ◽

pp. 556-566 ◽

Cited By ~ 4

Author(s):

Gwendolyn J. Gerner ◽

Eric I. Newman ◽

V. Joanna Burton ◽

Brenton Roman ◽

Elizabeth A. Cristofalo ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

White Matter ◽

Pilot Study ◽

Therapeutic Hypothermia ◽

Diffusion Tensor ◽

White Matter Injury ◽

Hypoxic Ischemic Encephalopathy ◽

Group Differences ◽

Neurodevelopmental Outcomes ◽

Ischemic Encephalopathy

Aim: Hypoxic-ischemic encephalopathy is associated with damage to deep gray matter; however, white matter involvement has become recognized. This study explored differences between patients and clinical controls on diffusion tensor imaging, and relationships between diffusion tensor imaging and neurodevelopmental outcomes. Method: Diffusion tensor imaging was obtained for 31 neonates after hypoxic-ischemic encephalopathy treated with therapeutic hypothermia and 10 clinical controls. A subgroup of patients with hypoxic-ischemic encephalopathy (n = 14) had neurodevelopmental outcomes correlated with diffusion tensor imaging scalars. Results: Group differences in diffusion tensor imaging scalars were observed in the putamen, anterior and posterior centrum semiovale, and the splenium of the corpus callosum. Differences in these regions of interest were correlated with neurodevelopmental outcomes between ages 20 and 32 months. Conclusion: Therapeutic hypothermia may not be a complete intervention for hypoxic-ischemic encephalopathy, as neonatal white matter changes may continue to be evident, but further research is warranted. Patterns of white matter change on neonatal diffusion tensor imaging correlated with neurodevelopmental outcomes in this exploratory pilot study.

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Induced Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy: Pathophysiology, Current Treatment, and Nursing Considerations

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/0730-0832.30.1.29 ◽

2011 ◽

Vol 30 (1) ◽

pp. 29-36 ◽

Cited By ~ 10

Author(s):

DeLinda Jo Cooper

Keyword(s):

Brain Injury ◽

Healing Process ◽

Current Treatment ◽

Therapeutic Interventions ◽

Hypoxic Ischemic Encephalopathy ◽

Second Phase ◽

Induced Hypothermia ◽

Compensatory Mechanism ◽

Neuroprotective Strategy ◽

Ischemic Encephalopathy

AbstractHypoxic-ischemic encephalopathy (HIE) can lead to devastating neurodevelopmental consequences such as cerebral palsy, seizure disorders, and significant developmental delays. HIE in the newborn is often the result of a hypoxic event, such as uterine rupture, placental abruption, or cord prolapse. Biphasic brain injury occurs in HIE. The first phase involves activation of the sympathetic nervous system as a compensatory mechanism. The second phase, known as reperfusion brain injury, occurs hours later. Induced hypothermia, a neuroprotective strategy for treating HIE, targets the second phase to prevent reperfusion injury. NICU nurses are in a unique position to detect patient instability and to maintain the therapeutic interventions that contribute to the healing process. This article highlights the significant role nurses play in the management of infants diagnosed with HIE who are treated with induced hypothermia.

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