scholarly journals Impaired cerebral autoregulation and brain injury in newborns with hypoxic-ischemic encephalopathy treated with hypothermia

2015 ◽  
Vol 114 (2) ◽  
pp. 818-824 ◽  
Author(s):  
An N. Massaro ◽  
R. B. Govindan ◽  
Gilbert Vezina ◽  
Taeun Chang ◽  
Nickie N. Andescavage ◽  
...  
Keyword(s):  
Brain Injury ◽  
Cerebral Autoregulation ◽  
Near Infrared ◽  
Right Hemisphere ◽  
Adverse Outcomes ◽  
Direct Care ◽  
Hypoxic Ischemic Encephalopathy ◽  
Perinatal Brain Injury ◽  
Arterial Blood ◽  
Ischemic Encephalopathy

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.

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

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.

scholarly journals Is Erythropoietin Combining with Therapeutic Hypothermia an Efficient and Safe Therapy in Neonatal Hypoxic Ischemic Encephalopathy: A Prospective and Randomized Clinical Trial

2020 ◽  
Author(s):  
Liang-yan Zou ◽  
Bing-xue Huang ◽  
Peng Zhang ◽  
Guo-qiang Cheng ◽  
Chun-mei Lu ◽  
...  
Keyword(s):  
Brain Injury ◽  
Adverse Events ◽  
Therapeutic Hypothermia ◽  
Brain Mri ◽  
Adverse Outcomes ◽  
Hypoxic Ischemic Encephalopathy ◽  
Control Group ◽  
Term Infants ◽  
Basal Nuclei ◽  
Ischemic Encephalopathy

Abstract BackgroundTo evaluate the efficacy and safety of erythropoietin (Epo) combined with therapeutic hypothermia (TH) in neonatal hypoxic-ischemic encephalopathy (HIE).MethodsA total of 78 term infants with HIE were assigned randomly to receive Epo (n = 40) or placebo (n = 38). All infants received TH. Blood samples before TH, after TH and after Epo/placebo were collected for measuring TH associated adverse events, Epo associated factors and potential neural biomarkers. Basal ganglia/ watershed (BG/W) scoring system was used to assess brain injury in MRI. Neurodevelopmental evaluations were performed at 18 months by using BayleyScales of Infant Development II (Bayley II).ResultsEpo-treated group tend to have lower serum creatine kinase (CK) concentration (114 vs 202, P = .04) and higher serum K+, Mg2+ concentration (5.0 vs 4.5, P = .03; 1.0 vs 0.9, P = .02) than control group after intervention. Brain MRI was performed in 65 (83%) neonatal. Totally brain injury score was in even distribution between two groups (median, 0 vs 0, P = .61), but injury region in cortex plus basal nuclei comparing with in basal nuclei solely was less common in the Epo than in the control group (21% vs 31%, P = .046). Only forty patients (40/78, 51%) succeeded in achieving 18-month follow up data. The totally adverse outcomes were trend to decline in the Epo group (35% vs 60%, P = .21). No adverse events were ascribed to Epo treatment.ConclusionsThe combination of Epo and TH is proved to be feasible, safe and potential effective.Trial registration: ChiCTR-TRC-14004532, date of registration: April 18th, 2014.

Neonatal Vitamin D Status Is Associated with the Severity of Brain Injury in Neonatal Hypoxic–Ischemic Encephalopathy: A Pilot Study

2020 ◽  
Vol 51 (04) ◽  
pp. 251-258
Author(s):  
Elizabeth A. McGinn ◽  
Andria Powers ◽  
Madeline Galas ◽  
Elizabeth Lyden ◽  
Eric S. Peeples
Keyword(s):  
Vitamin D ◽  
Brain Injury ◽  
Brain Magnetic Resonance Imaging ◽  
Vitamin D Supplementation ◽  
Adverse Outcomes ◽  
Hypoxic Ischemic Encephalopathy ◽  
Inverse Association ◽  
Vitamin D Levels ◽  
25Ohd Concentration ◽  
Ischemic Encephalopathy

Abstract Objective The primary aim of this study was to evaluate the association between 25-hydroxyvitamin D (25OHD) concentration at birth and the short-term outcomes in neonatal hypoxic–ischemic encephalopathy (HIE). Our secondary aim was to evaluate the effect of postnatal vitamin D supplementation on outcomes in the perinatal period after hypoxic injury. Study Design This retrospective cohort study included all infants ≥35 weeks gestation admitted to a regional level IV neonatal intensive care unit and diagnosed with moderate or severe HIE. Spearman correlation coefficients were used to evaluate associations between clinical outcomes including standardized brain magnetic resonance imaging (MRI) scores and either 25OHD concentrations in the first 48 hours of life or total vitamin D supplementation. Result A total of 43 infants met inclusion criteria; 22 had 25OHD concentrations drawn within the first 48 hours. There was a significant inverse association between 25OHD concentration and brain injury on MRI (p = 0.017). There was a trend toward decreased ventilator days in infants receiving higher doses of vitamin D in the first week of life (p = 0.062), but there was no association between vitamin D dosing and MRI injury. Conclusion These results support an association between lower vitamin-D levels and early adverse outcomes in HIE, including radiographic severity of brain injury.

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

2013 ◽  
Vol 14 (3) ◽  
pp. 310-317 ◽  
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

scholarly journals Elevated Temperature After Hypoxic-Ischemic Encephalopathy: Risk Factor for Adverse Outcomes

PEDIATRICS ◽  
2008 ◽  
Vol 122 (3) ◽  
pp. 491-499 ◽  
Author(s):  
A. Laptook ◽  
J. Tyson ◽  
S. Shankaran ◽  
S. McDonald ◽  
R. Ehrenkranz ◽  
...  
Keyword(s):  
Risk Factor ◽  
Elevated Temperature ◽  
Adverse Outcomes ◽  
Hypoxic Ischemic Encephalopathy ◽  
Ischemic Encephalopathy

Low Variability of Blood Pressure Predicts Abnormal Electroencephalogram in Infants with Hypoxic Ischemic Encephalopathy

2020 ◽  
Author(s):  
Abigail Flower ◽  
Daniel Vasiliu ◽  
Tianrui Zhu ◽  
Robert Andris ◽  
Maryam Abubakar ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Frequency Domain ◽  
Arterial Blood Pressure ◽  
Apgar Score ◽  
Blood Pressure Variability ◽  
Hypoxic Ischemic Encephalopathy ◽  
Arterial Blood ◽  
The Mean ◽  
Minute Apgar Score ◽  
Ischemic Encephalopathy

Objective This study aimed to evaluate the role of an objective physiologic biomarker, arterial blood pressure variability, for the early identification of adverse short-term electroencephalogram (EEG) outcomes in infants with hypoxic-ischemic encephalopathy (HIE). Study Design In this multicenter observational study, we analyzed blood pressure of infants meeting these criteria: (1) neonatal encephalopathy determined by modified Sarnat exam, (2) continuous mean arterial blood pressure (MABP) data between 18 and 27 hours after birth, and (3) continuous EEG performed for at least 48 hours. Adverse outcome was defined as moderate–severe grade EEG at 48 hours. Standardized signal preprocessing was used; the power spectral density was computed without interpolation. Multivariate binary logistic regression was used to identify which MABP time and frequency domain metrics provided improved predictive power for adverse outcomes compared with standard clinical predictors (5-minute Apgar score and cord pH) using receiver operator characteristic analysis. Results Ninety-one infants met inclusion criteria. The mean gestational age was 38.4 ± 1.8 weeks, the mean birth weight was 3,260 ± 591 g, 52/91 (57%) of infants were males, the mean cord pH was 6.95 ± 0.21, and 10/91 (11%) of infants died. At 48 hours, 58% of infants had normal or mildly abnormal EEG background and 42% had moderate or severe EEG backgrounds. Clinical predictor variables (10-minute Apgar score, Sarnat stage, and cord pH) were modestly predictive of 48 hours EEG outcome with area under curve (AUC) of 0.66 to 0.68. A composite model of clinical and optimal time- and frequency-domain blood pressure variability had a substantially improved AUC of 0.86. Conclusion Time- and frequency-domain blood pressure variability biomarkers offer a substantial improvement in prediction of later adverse EEG outcomes over perinatal clinical variables in a two-center cohort of infants with HIE. Key Points

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

2011 ◽  
Vol 30 (1) ◽  
pp. 29-36 ◽  
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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