A pilot cohort study of cerebral autoregulation and 2-year neurodevelopmental outcomes in neonates with hypoxic-ischemic encephalopathy who received therapeutic hypothermia

被引：66

作者：

Burton, Vera Joanna ^{[1
,2
,3
,9
]}

Gerner, Gwendolyn ^{[2
,4
]}

Cristofalo, Elizabeth ^{[1
,2
,5
]}

Chung, Shang-en ^{[6
]}

Jennings, Jacky M. ^{[6
]}

Parkinson, Charlamaine ^{[2
,5
]}

Koehler, Raymond C. ^{[7
]}

Chavez-Valdez, Raul ^{[2
,5
]}

Johnston, Michael V. ^{[1
,2
,3
,8
]}

Northington, Frances J. ^{[2
,5
]}

Lee, Jennifer K. ^{[2
,7
]}

机构：

[1] Kennedy Krieger Inst, Neurol & Dev Med, Baltimore, MD 21211 USA

[2] Johns Hopkins Sch Med, Neurosci Intens Care Nursery, Baltimore, MD 21205 USA

[3] Johns Hopkins Sch Med, Dept Neurol, Baltimore, MD 21205 USA

[4] Kennedy Krieger Inst, Dept Neuropsychol, Baltimore, MD USA

[5] Johns Hopkins Sch Med, Dept Pediat, Div Perinatal Neonatal Med, Baltimore, MD 21205 USA

[6] Johns Hopkins Sch Med, Dept Pediat, Ctr Child & Community Hlth Res CCHR, Baltimore, MD 21205 USA

[7] Johns Hopkins Sch Med, Dept Anesthesiol & Crit Care Med, Baltimore, MD 21205 USA

[8] Kennedy Krieger Inst, Hugo Moser Res Inst, Baltimore, MD USA

[9] Johns Hopkins Sch Med, Kennedy Krieger Inst, Dept Neurol & Dev Med, Baltimore, MD 21205 USA

来源：

BMC NEUROLOGY | 2015年 / 15卷

关键词：

Autoregulation; NIRS; Hypoxic-Ischemic Encephalopathy; Therapeutic Hypothermia; Neurodevelopmental Outcomes; NEAR-INFRARED SPECTROSCOPY; GROSS MOTOR FUNCTION; CEREBROVASCULAR AUTOREGULATION; BRAIN PERFUSION; BLOOD-FLOW; NEWBORNS; INJURY; PRESSURE; CHILDREN; SYSTEM;

D O I：

10.1186/s12883-015-0464-4

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background: Neurodevelopmental disabilities persist in survivors of neonatal hypoxic-ischemic encephalopathy (HIE) despite treatment with therapeutic hypothermia. Cerebrovascular autoregulation, the mechanism that maintains cerebral perfusion during changes in blood pressure, may influence outcomes. Our objective was to describe the relationship between acute autoregulatory vasoreactivity during treatment and neurodevelopmental outcomes at 2 years of age. Methods: In a pilot study of 28 neonates with HIE, we measured cerebral autoregulatory vasoreactivity with the hemoglobin volume index (HVx) during therapeutic hypothermia, rewarming, and the first 6 h of normothermia. The HVx, which is derived from near-infrared spectroscopy, was used to identify the individual optimal mean arterial blood pressure (MAPOPT) at which autoregulatory vasoreactivity is greatest. Cognitive and motor neurodevelopmental evaluations were completed in 19 children at 21-32 months of age. MAPOPT, blood pressure in relation to MAPOPT, blood pressure below gestational age + 5 (ga + 5), and regional cerebral oximetry (rSO(2)) were compared to the neurodevelopmental outcomes. Results: Nineteen children who had HIE and were treated with therapeutic hypothermia performed in the average range on cognitive and motor evaluations at 21-32 months of age, although the mean performance was lower than that of published normative samples. Children with impairments at the 2-year evaluation had higher MAPOPT values, spent more time with blood pressure below MAPOPT, and had greater blood pressure deviation below MAPOPT during rewarming in the neonatal period than those without impairments. Greater blood pressure deviation above MAPOPT during rewarming was associated with less disability and higher cognitive scores. No association was observed between rSO2 or blood pressure below ga + 5 and neurodevelopmental outcomes. Conclusion: In this pilot cohort, motor and cognitive impairments at 21-32 months of age were associated with greater blood pressure deviation below MAPOPT during rewarming following therapeutic hypothermia, but not with rSO(2) or blood pressure below ga + 5. This suggests that identifying individual neonates' MAPOPT is superior to using hemodynamic goals based on gestational age or rSO(2) in the acute management of neonatal HIE.

引用

页数：13

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