Journal
PEDIATRIC RESEARCH
Volume 74, Issue 5, Pages 525-535Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/pr.2013.132
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Funding
- Covidien (Boulder, CO)
- Thomas Wilson Sanitarium for Children of Baltimore City research foundation (Baltimore, MD)
- American Heart Association (Dallas, TX)
- International Anesthesia Research Society (San Francisco, CA)
- National Institutes of Health (NIH), Bethesda, MD [NS060703, HD070996]
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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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