Cerebrovascular autoregulation and neurologic injury in neonatal hypoxic-ischemic encephalopathy

Jessica A. Howlett, Frances J. Northington, Maureen M. Gilmore, Aylin Tekes, Thierry A.G.M. Huisman, Charlamaine Parkinson, Shang En Chung, Jacky M. Jennings, Jessica J. Jamrogowicz, Abby C. Larson, Christoph U. Lehmann, Eric Jackson, Ken M. Brady, Raymond C. Koehler, Jennifer K. Lee

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Background:Neonates with hypoxic-ischemic encephalopathy (HIE) are at risk of cerebral blood flow dysregulation. Our objective was to describe the relationship between autoregulation and neurologic injury in HIE.Methods:Neonates with HIE had autoregulation monitoring with the hemoglobin volume index (HVx) during therapeutic hypothermia, rewarming, and the first 6 h of normothermia. The 5-mm Hg range of mean arterial blood pressure (MAP) with best vasoreactivity (MAP OPT) was identified. The percentage of time spent with MAP below MAP OPT and deviation in MAP from MAP OPT were measured. Neonates received brain magnetic resonance imaging (MRI) 3-7 d after treatment. MRIs were coded as no, mild, or moderate/severe injury in five regions.Results:HVx identified MAP OPT in 79% (19/24), 77% (17/22), and 86% (18/21) of the neonates during hypothermia, rewarming, and normothermia, respectively. Neonates with moderate/severe injury in paracentral gyri, white matter, basal ganglia, and thalamus spent a greater proportion of time with MAP below MAP OPT during rewarming than neonates with no or mild injury. Neonates with moderate/severe injury in paracentral gyri, basal ganglia, and thalamus had greater MAP deviation below MAP OPT during rewarming than neonates without injury.Conclusion:Maintaining MAP within or above MAP OPT may reduce the risk of neurologic injuries in neonatal HIE.

Original languageEnglish (US)
Pages (from-to)525-535
Number of pages11
JournalPediatric Research
Volume74
Issue number5
DOIs
StatePublished - Nov 1 2013
Externally publishedYes

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Nervous System Trauma
Brain Hypoxia-Ischemia
Arterial Pressure
Homeostasis
Rewarming
Wounds and Injuries
Basal Ganglia
Thalamus

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Howlett, J. A., Northington, F. J., Gilmore, M. M., Tekes, A., Huisman, T. A. G. M., Parkinson, C., ... Lee, J. K. (2013). Cerebrovascular autoregulation and neurologic injury in neonatal hypoxic-ischemic encephalopathy. Pediatric Research, 74(5), 525-535. https://doi.org/10.1038/pr.2013.132

Cerebrovascular autoregulation and neurologic injury in neonatal hypoxic-ischemic encephalopathy. / Howlett, Jessica A.; Northington, Frances J.; Gilmore, Maureen M.; Tekes, Aylin; Huisman, Thierry A.G.M.; Parkinson, Charlamaine; Chung, Shang En; Jennings, Jacky M.; Jamrogowicz, Jessica J.; Larson, Abby C.; Lehmann, Christoph U.; Jackson, Eric; Brady, Ken M.; Koehler, Raymond C.; Lee, Jennifer K.

In: Pediatric Research, Vol. 74, No. 5, 01.11.2013, p. 525-535.

Research output: Contribution to journalArticle

Howlett, JA, Northington, FJ, Gilmore, MM, Tekes, A, Huisman, TAGM, Parkinson, C, Chung, SE, Jennings, JM, Jamrogowicz, JJ, Larson, AC, Lehmann, CU, Jackson, E, Brady, KM, Koehler, RC & Lee, JK 2013, 'Cerebrovascular autoregulation and neurologic injury in neonatal hypoxic-ischemic encephalopathy', Pediatric Research, vol. 74, no. 5, pp. 525-535. https://doi.org/10.1038/pr.2013.132
Howlett JA, Northington FJ, Gilmore MM, Tekes A, Huisman TAGM, Parkinson C et al. Cerebrovascular autoregulation and neurologic injury in neonatal hypoxic-ischemic encephalopathy. Pediatric Research. 2013 Nov 1;74(5):525-535. https://doi.org/10.1038/pr.2013.132
Howlett, Jessica A. ; Northington, Frances J. ; Gilmore, Maureen M. ; Tekes, Aylin ; Huisman, Thierry A.G.M. ; Parkinson, Charlamaine ; Chung, Shang En ; Jennings, Jacky M. ; Jamrogowicz, Jessica J. ; Larson, Abby C. ; Lehmann, Christoph U. ; Jackson, Eric ; Brady, Ken M. ; Koehler, Raymond C. ; Lee, Jennifer K. / Cerebrovascular autoregulation and neurologic injury in neonatal hypoxic-ischemic encephalopathy. In: Pediatric Research. 2013 ; Vol. 74, No. 5. pp. 525-535.
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AU - Howlett, Jessica A.

AU - Northington, Frances J.

AU - Gilmore, Maureen M.

AU - Tekes, Aylin

AU - Huisman, Thierry A.G.M.

AU - Parkinson, Charlamaine

AU - Chung, Shang En

AU - Jennings, Jacky M.

AU - Jamrogowicz, Jessica J.

AU - Larson, Abby C.

AU - Lehmann, Christoph U.

AU - Jackson, Eric

AU - Brady, Ken M.

AU - Koehler, Raymond C.

AU - Lee, Jennifer K.

PY - 2013/11/1

Y1 - 2013/11/1

N2 - Background:Neonates with hypoxic-ischemic encephalopathy (HIE) are at risk of cerebral blood flow dysregulation. Our objective was to describe the relationship between autoregulation and neurologic injury in HIE.Methods:Neonates with HIE had autoregulation monitoring with the hemoglobin volume index (HVx) during therapeutic hypothermia, rewarming, and the first 6 h of normothermia. The 5-mm Hg range of mean arterial blood pressure (MAP) with best vasoreactivity (MAP OPT) was identified. The percentage of time spent with MAP below MAP OPT and deviation in MAP from MAP OPT were measured. Neonates received brain magnetic resonance imaging (MRI) 3-7 d after treatment. MRIs were coded as no, mild, or moderate/severe injury in five regions.Results:HVx identified MAP OPT in 79% (19/24), 77% (17/22), and 86% (18/21) of the neonates during hypothermia, rewarming, and normothermia, respectively. Neonates with moderate/severe injury in paracentral gyri, white matter, basal ganglia, and thalamus spent a greater proportion of time with MAP below MAP OPT during rewarming than neonates with no or mild injury. Neonates with moderate/severe injury in paracentral gyri, basal ganglia, and thalamus had greater MAP deviation below MAP OPT during rewarming than neonates without injury.Conclusion:Maintaining MAP within or above MAP OPT may reduce the risk of neurologic injuries in neonatal HIE.

AB - Background:Neonates with hypoxic-ischemic encephalopathy (HIE) are at risk of cerebral blood flow dysregulation. Our objective was to describe the relationship between autoregulation and neurologic injury in HIE.Methods:Neonates with HIE had autoregulation monitoring with the hemoglobin volume index (HVx) during therapeutic hypothermia, rewarming, and the first 6 h of normothermia. The 5-mm Hg range of mean arterial blood pressure (MAP) with best vasoreactivity (MAP OPT) was identified. The percentage of time spent with MAP below MAP OPT and deviation in MAP from MAP OPT were measured. Neonates received brain magnetic resonance imaging (MRI) 3-7 d after treatment. MRIs were coded as no, mild, or moderate/severe injury in five regions.Results:HVx identified MAP OPT in 79% (19/24), 77% (17/22), and 86% (18/21) of the neonates during hypothermia, rewarming, and normothermia, respectively. Neonates with moderate/severe injury in paracentral gyri, white matter, basal ganglia, and thalamus spent a greater proportion of time with MAP below MAP OPT during rewarming than neonates with no or mild injury. Neonates with moderate/severe injury in paracentral gyri, basal ganglia, and thalamus had greater MAP deviation below MAP OPT during rewarming than neonates without injury.Conclusion:Maintaining MAP within or above MAP OPT may reduce the risk of neurologic injuries in neonatal HIE.

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