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Fedriga M, Martini S, Iodice FG, Sortica da Costa C, Pezzato S, Moscatelli A, Beqiri E, Czosnyka M, Smielewski P, Agrawal S. Cerebral autoregulation in paediatric and neonatal intensive care: A scoping review. J Cereb Blood Flow Metab 2024:271678X241261944. [PMID: 38867574 DOI: 10.1177/0271678x241261944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
Deranged cerebral autoregulation (CA) is associated with worse outcome in adult brain injury. Strategies for monitoring CA and maintaining the brain at its 'best CA status' have been implemented, however, this approach has not yet developed for the paediatric population. This scoping review aims to find up-to-date evidence on CA assessment in children and neonates with a view to identify patient categories in which CA has been measured so far, CA monitoring methods and its relationship with clinical outcome if any. A literature search was conducted for studies published within 31st December 2022 in 3 bibliographic databases. Out of 494 papers screened, this review includes 135 studies. Our literature search reveals evidence for CA measurement in the paediatric population across different diagnostic categories and age groups. The techniques adopted, indices and thresholds used to assess and define CA are heterogeneous. We discuss the relevance of available evidence for CA assessment in the paediatric population. However, due to small number of studies and heterogeneity of methods used, there is no conclusive evidence to support universal adoption of CA monitoring, technique, and methodology. This calls for further work to understand the clinical impact of CA monitoring in paediatric and neonatal intensive care.
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Affiliation(s)
- Marta Fedriga
- Neonatal and Paediatric Intensive Care Unit, IRCCS Giannina Gaslini Institute, Genoa, Italy
| | - Silvia Martini
- Neonatal Intensive Care Unit, IRCCS AOUBO, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Francesca G Iodice
- Paediatric Cardiac Anaesthesia and Intensive Care Unit, IRCCS, Bambino Gesu' Hospital, Rome, Italy
| | | | - Stefano Pezzato
- Neonatal and Paediatric Intensive Care Unit, IRCCS Giannina Gaslini Institute, Genoa, Italy
| | - Andrea Moscatelli
- Neonatal and Paediatric Intensive Care Unit, IRCCS Giannina Gaslini Institute, Genoa, Italy
| | - Erta Beqiri
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Marek Czosnyka
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Peter Smielewski
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Shruti Agrawal
- Department of Paediatric Intensive Care, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
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Chao H, Acosta S, Rusin C, Rhee C. Comparison of Near-Infrared Spectroscopy-Based Cerebral Autoregulatory Indices in Extremely Low Birth Weight Infants. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1361. [PMID: 37628360 PMCID: PMC10453436 DOI: 10.3390/children10081361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/20/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Premature infants are born with immature cerebral autoregulation function and are vulnerable to pressure passive cerebral circulation and subsequent brain injury. Measurements derived from near-infrared spectroscopy (NIRS) have enabled continuous assessment of cerebral vasoreactivity. Although NIRS has enabled a growing field of research, the lack of clear standardization in the field remains problematic. A major limitation of current literature is the absence of a comparative analysis of the different methodologies. OBJECTIVES To determine the relationship between NIRS-derived continuous indices of cerebral autoregulation in a cohort of extremely low birth weight (ELBW) infants. METHODS Premature infants of birth weight 401-1000 g were studied during the first 72 h of life. The cerebral oximetry index (COx), hemoglobin volume index (HVx), and tissue oxygenation heart rate reactivity index (TOHRx) were simultaneously calculated. The relationship between each of the indices was assessed with Pearson correlation. RESULTS Fifty-eight infants with a median gestational age of 25.8 weeks and a median birth weight of 738 g were included. Intraventricular hemorrhage (IVH) was detected in 33% of individuals. COx and HVx demonstrated the highest degree of correlation, although the relationship was moderate at best (r = 0.543, p < 0.001). No correlation was found either between COx and TOHRx (r = 0.318, p < 0.015) or between HVx and TOHRx (r = 0.287, p < 0.029). No significant differences in these relationships were found with respect to IVH and no IVH in subgroup analysis. CONCLUSIONS COx, HVx, and TOHRx are not numerically equivalent. Caution must be applied when interpreting or comparing results based on different methodologies for measuring cerebral autoregulation. Uniformity regarding data acquisition and analytical methodology are needed to firmly establish a gold standard for neonatal cerebral autoregulation monitoring.
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Affiliation(s)
- Howard Chao
- Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX 77030, USA
| | - Sebastian Acosta
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX 77030, USA
| | - Craig Rusin
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX 77030, USA
| | - Christopher Rhee
- Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX 77030, USA
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Abstract
Advances in perinatal care have seen substantial improvements in survival without disability for extremely preterm infants. Protecting the developing brain and reducing neurodevelopmental sequelae of extremely preterm birth are strategic priorities for both research and clinical care. A number of evidence-based interventions exist for neuroprotection in micropreemies, inclusive of prevention of preterm birth and multiple births with implantation of only one embryo during in vitro fertilisation, as well as antenatal care to optimize fetal wellbeing, strategies for supporting neonatal transition, and neuroprotective developmental care. Avoidance of complications that trigger ischemia and inflammation is vital for minimizing brain dysmaturation and injury, particularly of the white matter. Neurodevelopmental surveillance, early diagnosis of cerebral palsy and early intervention are essential for optimizing long-term outcomes and quality of life. Research priorities include further evaluation of putative neuroprotective agents, and investigation of common neonatal interventions in trials adequately powered to assess neurodevelopmental outcome.
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Cerebral oxygen saturation and autoregulation during hypotension in extremely preterm infants. Pediatr Res 2021; 90:373-380. [PMID: 33879849 DOI: 10.1038/s41390-021-01483-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 02/23/2021] [Accepted: 03/04/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The impact of the permissive hypotension approach in clinically well infants on regional cerebral oxygen saturation (rScO2) and autoregulatory capacity (CAR) remains unknown. METHODS Prospective cohort study of blinded rScO2 measurements within a randomized controlled trial of management of hypotension (HIP trial) in extremely preterm infants. rScO2, mean arterial blood pressure, duration of cerebral hypoxia, and transfer function (TF) gain inversely proportional to CAR, were compared between hypotensive infants randomized to receive dopamine or placebo and between hypotensive and non-hypotensive infants, and related to early intraventricular hemorrhage or death. RESULTS In 89 potentially eligible HIP trial patients with rScO2 measurements, the duration of cerebral hypoxia was significantly higher in 36 hypotensive compared to 53 non-hypotensive infants. In 29/36 hypotensive infants (mean GA 25 weeks, 69% males) receiving the study drug, no significant difference in rScO2 was observed after dopamine (n = 13) compared to placebo (n = 16). Duration of cerebral hypoxia was associated with early intraventricular hemorrhage or death. Calculated TF gain (n = 49/89) was significantly higher reflecting decreased CAR in 16 hypotensive compared to 33 non-hypotensive infants. CONCLUSIONS Dopamine had no effect on rScO2 compared to placebo in hypotensive infants. Hypotension and cerebral hypoxia are associated with early intraventricular hemorrhage or death. IMPACT Treatment of hypotension with dopamine in extremely preterm infants increases mean arterial blood pressure, but does not improve cerebral oxygenation. Hypotensive extremely preterm infants have increased duration of cerebral hypoxia and reduced cerebral autoregulatory capacity compared to non-hypotensive infants. Duration of cerebral hypoxia and hypotension are associated with early intraventricular hemorrhage or death in extremely preterm infants. Since systematic treatment of hypotension may not be associated with better outcomes, the diagnosis of cerebral hypoxia in hypotensive extremely preterm infants might guide treatment.
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Costa FG, Hakimi N, Van Bel F. Neuroprotection of the Perinatal Brain by Early Information of Cerebral Oxygenation and Perfusion Patterns. Int J Mol Sci 2021; 22:ijms22105389. [PMID: 34065460 PMCID: PMC8160954 DOI: 10.3390/ijms22105389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/07/2021] [Accepted: 05/17/2021] [Indexed: 02/01/2023] Open
Abstract
Abnormal patterns of cerebral perfusion/oxygenation are associated with neuronal damage. In preterm neonates, hypoxemia, hypo-/hypercapnia and lack of cerebral autoregulation are related to peri-intraventricular hemorrhages and white matter injury. Reperfusion damage after perinatal hypoxic ischemia in term neonates seems related with cerebral hyperoxygenation. Since biological tissue is transparent for near infrared (NIR) light, NIR-spectroscopy (NIRS) is a noninvasive bedside tool to monitor brain oxygenation and perfusion. This review focuses on early assessment and guiding abnormal cerebral oxygenation/perfusion patterns to possibly reduce brain injury. In term infants, early patterns of brain oxygenation helps to decide whether or not therapy (hypothermia) and add-on therapies should be considered. Further NIRS-related technical advances such as the use of (functional) NIRS allowing simultaneous estimation and integrating of heart rate, respiration rate and monitoring cerebral autoregulation will be discussed.
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Affiliation(s)
- Filipe Gonçalves Costa
- Department of Neonatology, University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands; (F.G.C.); (N.H.)
| | - Naser Hakimi
- Department of Neonatology, University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands; (F.G.C.); (N.H.)
- Artinis Medical Systems, B.V., 6662 PW Elst, The Netherlands
| | - Frank Van Bel
- Department of Neonatology, University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands; (F.G.C.); (N.H.)
- Correspondence: ; Tel.: +31-887-554-545
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Abstract
BACKGROUND The altered neurodevelopment of children operated on during the neonatal period might be due to peri-operative changes in the homeostasis of brain perfusion. Monitoring of vital signs is a standard of care, but it does not usually include monitoring of the brain. OBJECTIVES To evaluate methods of monitoring the brain that might be of value. We also wanted to clarify if there are specific risk factors that result in peri-operative changes and how this might be evaluated. DESIGN Systematic review. DATA SOURCES A structured literature search was performed in MEDLINE in Ovid, Embase, Cochrane CENTRAL, Web of Science and Google Scholar. ELIGIBILITY CRITERIA Studies in neonates who received peri-operative neuromonitoring were eligible for inclusion; studies on neurosurgical procedures or cardiac surgery with cardiopulmonary bypass and/or deep hypothermia cardiac arrest were excluded. RESULTS Nineteen of the 24 included studies, totalling 374 infants, reported the use of near-infrared spectroscopy. Baseline values of cerebral oxygenation greatly varied (mean 53 to 91%) and consequently, no coherent results were found. Two studies found a correlation between cerebral oxygenation and mean arterial blood pressure. Five studies, with in total 388 infants, used (amplitude-integrated) electro-encephalography to study peri-operative brain activity. Overall, the brain activity decreased during anaesthesia and epileptic activity was more frequent in the peri-operative phase. The association between intra-operative cerebral saturation or activity and neuro-imaging abnormalities and/or neurodevelopmental outcome was investigated in six studies, but no association was found. CONCLUSION Neuromonitoring with the techniques currently used will neither help our understanding of the altered neonatal pathophysiology, nor enable early detection of deviation from the norm. The modalities lack specificity and are not related to clinical (long-term) outcome or prognosis. Accordingly, we were unable to draw up a monitoring guideline.
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Kermorgant M, Nasr N, Czosnyka M, Arvanitis DN, Hélissen O, Senard JM, Pavy-Le Traon A. Impacts of Microgravity Analogs to Spaceflight on Cerebral Autoregulation. Front Physiol 2020; 11:778. [PMID: 32719617 PMCID: PMC7350784 DOI: 10.3389/fphys.2020.00778] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/15/2020] [Indexed: 12/16/2022] Open
Abstract
It is well known that exposure to microgravity in astronauts leads to a plethora physiological responses such as headward fluid shift, body unloading, and cardiovascular deconditioning. When astronauts return to Earth, some encounter problems related to orthostatic intolerance. An impaired cerebral autoregulation (CA), which could be compromised by the effects of microgravity, has been proposed as one of the mechanisms responsible for orthostatic intolerance. CA is a homeostatic mechanism that maintains cerebral blood flow for any variations in cerebral perfusion pressure by adapting the vascular tone and cerebral vessel diameter. The ground-based models of microgravity are useful tools for determining the gravitational impact of spaceflight on human body. The head-down tilt bed rest (HDTBR), where the subject remains in supine position at −6 degrees for periods ranging from few days to several weeks is the most commonly used ground-based model of microgravity for cardiovascular deconditioning. head-down bed rest (HDBR) is able to replicate cephalic fluid shift, immobilization, confinement, and inactivity. Dry immersion (DI) model is another approach where the subject remains immersed in thermoneutral water covered with an elastic waterproof fabric separating the subject from the water. Regarding DI, this analog imitates absence of any supporting structure for the body, centralization of body fluids, immobilization and hypokinesia observed during spaceflight. However, little is known about the impact of microgravity on CA. Here, we review the fundamental principles and the different mechanisms involved in CA. We also consider the different approaches in order to assess CA. Finally, we focus on the effects of short- and long-term spaceflight on CA and compare these findings with two specific analogs to microgravity: HDBR and DI.
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Affiliation(s)
- Marc Kermorgant
- INSERM UMR 1048, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse, France
| | - Nathalie Nasr
- INSERM UMR 1048, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse, France.,Department of Neurology, Institute for Neurosciences, Toulouse University Hospital, Toulouse, France
| | - Marek Czosnyka
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge University Hospital, Cambridge, United Kingdom.,Institute of Electronic Systems, Warsaw University of Technology, Warsaw, Poland
| | - Dina N Arvanitis
- INSERM UMR 1048, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse, France
| | - Ophélie Hélissen
- INSERM UMR 1048, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse, France
| | - Jean-Michel Senard
- INSERM UMR 1048, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse, France.,Department of Clinical Pharmacology, Toulouse University Hospital, Toulouse, France
| | - Anne Pavy-Le Traon
- INSERM UMR 1048, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse, France.,Department of Neurology, Institute for Neurosciences, Toulouse University Hospital, Toulouse, France
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Cohen E, Baerts W, Caicedo Dorado A, Naulaers G, van Bel F, Lemmers PMA. Cerebrovascular autoregulation in preterm fetal growth restricted neonates. Arch Dis Child Fetal Neonatal Ed 2019; 104:F467-F472. [PMID: 30355781 DOI: 10.1136/archdischild-2017-313712] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/12/2018] [Accepted: 09/22/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate the effect of fetal growth restriction (FGR) on cerebrovascular autoregulation in preterm neonates during the first 3 days of life. DESIGN Case-control study. SETTING Neonatal intensive care unit of the Wilhelmina Children's Hospital, The Netherlands. PATIENTS 57 FGR (birth weight <10th percentile) and 57 appropriate for gestational age (AGA) (birth weight 20th-80th percentiles) preterm neonates, matched for gender, gestational age, respiratory and blood pressure support. METHODS The correlation between continuously measured mean arterial blood pressure and regional cerebral oxygen saturation was calculated to generate the cerebral oximetry index (COx). Mean COx was calculated for each patient for each postnatal day. The percentage of time with impaired autoregulation (COx>0.5) was also calculated. RESULTS FGR neonates had higher mean COx values than their AGA peers on day 2 (0.15 (95% CI 0.11 to 0.18) vs 0.09 (95% CI 0.06 to 0.13), p=0.029) and day 3 (0.17 (95% CI 0.13 to 0.20) vs 0.09 (95% CI 0.06 to 0.12), p=0.003) of life. FGR neonates spent more time with impaired autoregulation (COx value >0.5) than controls on postnatal day 2 (19% (95% CI 16% to 22%) vs 14% (95% CI 12% to 17%), p=0.035) and day 3 (20% (95% CI 17% to 24%) vs 15% (95% CI 12% to 18%), p=0.016). CONCLUSION FGR preterm neonates more frequently display impaired cerebrovascular autoregulation compared with AGA peers on days 2 and 3 of life which may predispose them to brain injury. Further studies are required to investigate whether this impairment persists beyond the first few days of life and whether this impairment is linked to poor neurodevelopmental outcome.
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Affiliation(s)
- Emily Cohen
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Centre Utrecht, Utrecht, The Netherlands.,The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Willem Baerts
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Alexander Caicedo Dorado
- Department of Applied Mathematics and Computer Science, Faculty of Natural Sciences and Mathematics, Universidad del Rosario, Bogota, Colombia
| | - Gunnar Naulaers
- Department of Neonatology, University Hospital Leuven, Leuven, Belgium
| | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Petra M A Lemmers
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Centre Utrecht, Utrecht, The Netherlands
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9
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Why and how to assess cerebral autoregulation? Best Pract Res Clin Anaesthesiol 2019; 33:211-220. [DOI: 10.1016/j.bpa.2019.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 05/13/2019] [Accepted: 05/16/2019] [Indexed: 02/07/2023]
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10
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Thewissen L, Caicedo A, Dereymaeker A, Van Huffel S, Naulaers G, Allegaert K, Smits A. Cerebral autoregulation and activity after propofol for endotracheal intubation in preterm neonates. Pediatr Res 2018; 84:719-725. [PMID: 30201953 DOI: 10.1038/s41390-018-0160-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/12/2018] [Accepted: 08/10/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite increasing use of propofol in neonates, observations on cerebral effects are limited. AIM To investigate cerebral autoregulation (CAR) and activity after propofol for endotracheal intubation in preterm neonates. METHODS Twenty-two neonates received propofol before intubation as part of a published dose-finding study. Mean arterial blood pressure (MABP), near-infrared spectroscopy-derived cerebral oxygenation (rScO2), and amplitude-integrated electroencephalography (aEEG) were analyzed until 180 min after propofol. CAR was expressed as transfer function (TF) gain, indicating % change in rScO2 per 1 mmHg change in MABP. Values exceeding mean TF gain + 2 standard deviations (SD) defined impaired CAR. RESULTS After intubation with a median propofol dose of 1 (0.5-4.5) mg/kg, rScO2 remained stable during decreasing MABP. Mean (±SD) TF gain was 0.8 (±0.3)%/mmHg. Impaired CAR was identified in 1 and 5 patient(s) during drug-related hypotension and normal to raised MABP, respectively. Suppressed aEEG was observed up to 60 min after propofol. CONCLUSIONS Drug-related hypotension and decreased cerebral activity after intubation with low propofol doses in preterm neonates were observed, without evidence of cerebral ischemic hypoxia. CAR remained intact during drug-related hypotension in 95.5% of patients. Cerebral monitoring including CAR clarifies the cerebral impact of MABP fluctuations.
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Affiliation(s)
- Liesbeth Thewissen
- Department of Neonatology, University Hospitals Leuven, Leuven, Belgium.
| | - Alexander Caicedo
- Department of Electrical Engineering, ESAT-Stadius, KU Leuven, Leuven, Belgium
| | | | - Sabine Van Huffel
- Department of Electrical Engineering, ESAT-Stadius, KU Leuven, Leuven, Belgium
| | - Gunnar Naulaers
- Department of Neonatology, University Hospitals Leuven, Leuven, Belgium
| | - Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Anne Smits
- Department of Neonatology, University Hospitals Leuven, Leuven, Belgium
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11
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Tran NN, Kumar SR, Hodge FS, Macey PM. Cerebral Autoregulation in Neonates With and Without Congenital Heart Disease. Am J Crit Care 2018; 27:410-416. [PMID: 30173174 DOI: 10.4037/ajcc2018672] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Congenital heart disease (CHD) is a leading birth defect in the United States, affecting about 40 000 neonates each year. Despite efforts to prevent developmental delays, many children with CHD have neurological deficits that last into adulthood, influencing employability, self-care, and quality of life. OBJECTIVE To determine if neonates with CHD have impaired cerebral autoregulation and poorer neurodevelopmental outcomes compared with healthy controls. METHODS A total of 44 full-term neonates, 28 with CHD and 16 without, were enrolled in the study. Inclusion criteria included confirmed diagnosis of CHD, stable hemodynamic status, and being no more than 12 days old. Exclusion criteria included intraventricular hemorrhage and intubation. Cerebral autoregulation was determined by measuring regional cerebral oxygenation during a postural change. The Einstein Neonatal Neurobehavioral Assessment Scale was used to measure overall neurodevelopmental outcomes (motor, visual, and auditory functions). RESULTS Of the 28 neonates with CHD, 8 had single-ventricle physiology. A χ2 analysis indicated no significant difference in impaired cerebral autoregulation between neonates with CHD and controls (P = .38). Neonates with CHD had lower regional cerebral oxygenation than did neonates without CHD (P < .001). Regression analyses with adjustments for cerebral autoregulation indicated that neonates with CHD had poorer total neurodevelopmental outcomes scores (β = 9.3; P = .02) and motor scores (β = 7.6; P = .04). CONCLUSION Preoperative neonates with CHD have poorer developmental outcomes and more hypoxemia than do controls.
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Affiliation(s)
- Nhu N. Tran
- Nhu N. Tran is a clinical research nurse III, Department of Cardiothoracic Surgery, Children’s Hospital Los Angeles, Los Angeles, California. Ram Kumar is an assistant professor of surgery, Keck School of Medicine, University of Southern California, Los Angeles, California. Felicia S. Hodge is a professor and Paul M. Macey is an associate professor, School of Nursing, University of California, Los Angeles
| | - S. Ram Kumar
- Nhu N. Tran is a clinical research nurse III, Department of Cardiothoracic Surgery, Children’s Hospital Los Angeles, Los Angeles, California. Ram Kumar is an assistant professor of surgery, Keck School of Medicine, University of Southern California, Los Angeles, California. Felicia S. Hodge is a professor and Paul M. Macey is an associate professor, School of Nursing, University of California, Los Angeles
| | - Felicia S. Hodge
- Nhu N. Tran is a clinical research nurse III, Department of Cardiothoracic Surgery, Children’s Hospital Los Angeles, Los Angeles, California. Ram Kumar is an assistant professor of surgery, Keck School of Medicine, University of Southern California, Los Angeles, California. Felicia S. Hodge is a professor and Paul M. Macey is an associate professor, School of Nursing, University of California, Los Angeles
| | - Paul M. Macey
- Nhu N. Tran is a clinical research nurse III, Department of Cardiothoracic Surgery, Children’s Hospital Los Angeles, Los Angeles, California. Ram Kumar is an assistant professor of surgery, Keck School of Medicine, University of Southern California, Los Angeles, California. Felicia S. Hodge is a professor and Paul M. Macey is an associate professor, School of Nursing, University of California, Los Angeles
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12
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Beausoleil TP, Janaillac M, Barrington KJ, Lapointe A, Dehaes M. Cerebral oxygen saturation and peripheral perfusion in the extremely premature infant with intraventricular and/or pulmonary haemorrhage early in life. Sci Rep 2018; 8:6511. [PMID: 29695729 PMCID: PMC5916916 DOI: 10.1038/s41598-018-24836-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/09/2018] [Indexed: 12/29/2022] Open
Abstract
Extremely preterm infants are at higher risk of pulmonary (PH) and intraventricular (IVH) haemorrhage during the transitioning physiology due to immature cardiovascular system. Monitoring of haemodynamics can detect early abnormal circulation that may lead to these complications. We described time-frequency relationships between near infrared spectroscopy (NIRS) cerebral regional haemoglobin oxygen saturation (CrSO2) and preductal peripheral perfusion index (PI), capillary oxygen saturation (SpO2) and heart rate (HR) in extremely preterm infants in the first 72 h of life. Patients were sub-grouped in infants with PH and/or IVH (N H = 8) and healthy controls (N C = 11). Data were decomposed in wavelets allowing the analysis of localized variations of power. This approach allowed to quantify the percentage of time of significant cross-correlation, semblance, gain (transfer function) and coherence between signals. Ultra-low frequencies (<0.28 mHz) were analyzed as slow and prolonged periods of impaired circulation are considered more detrimental than transient fluctuations. Cross-correlation between CrSO2 and oximetry (PI, SpO2 and HR) as well as in-phase semblance and gain between CrSO2 and HR were significantly lower while anti-phase semblance between CrSO2 and HR was significantly higher in PH-IVH infants compared to controls. These differences may reflect haemodynamic instability associated with cerebrovascular autoregulation and hemorrhagic complications observed during the transitioning physiology.
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Affiliation(s)
- Thierry P Beausoleil
- Institute of Biomedical Engineering, University of Montréal, Montréal, Canada.,Research Centre, CHU Sainte-Justine, Montréal, Canada
| | - Marie Janaillac
- Department of Pediatrics, Division of Neonatology, CHU Sainte-Justine and University of Montréal, Montréal, Canada
| | - Keith J Barrington
- Research Centre, CHU Sainte-Justine, Montréal, Canada.,Department of Pediatrics, Division of Neonatology, CHU Sainte-Justine and University of Montréal, Montréal, Canada
| | - Anie Lapointe
- Department of Pediatrics, Division of Neonatology, CHU Sainte-Justine and University of Montréal, Montréal, Canada
| | - Mathieu Dehaes
- Research Centre, CHU Sainte-Justine, Montréal, Canada. .,Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montréal, Montréal, Canada.
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13
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Abstract
PURPOSE OF REVIEW There has been a significant increase in the utilization of NIRS in neonatal care over the last few years, with some centers now routinely utilizing this monitoring technique for direct intervention at the bedside. In this review, we provide a summary of the most up-to-date evidence on near infrared spectroscopy utilization, with particular emphasis on measurement of cerebral oxygenation in preterm infants. RECENT FINDINGS There have been significant advances in the technology, leading to an increase in the number of available devices and in the use of this monitoring tool to reduce cerebral injury in preterm infants. The role of NIRS in assessing cerebral autoregulation in preterm and term infants, in evaluating somatic oxygenation, and in the management of newborns with hypoxic ischaemic encephalopathy is discussed. SUMMARY Two recent pilot randomized controlled trials highlight the potential of cerebral oxygenation monitoring to direct management in the delivery room and the neonatal intensive care unit. However, we urge caution against routine use and await the results of further studies in this area before considering this type of monitoring as standard of care.
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Thewissen L, Caicedo A, Lemmers P, Van Bel F, Van Huffel S, Naulaers G. Measuring Near-Infrared Spectroscopy Derived Cerebral Autoregulation in Neonates: From Research Tool Toward Bedside Multimodal Monitoring. Front Pediatr 2018; 6:117. [PMID: 29868521 PMCID: PMC5960703 DOI: 10.3389/fped.2018.00117] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 04/11/2018] [Indexed: 12/30/2022] Open
Abstract
Introduction: Cerebral autoregulation (CAR), the ability of the human body to maintain cerebral blood flow (CBF) in a wide range of perfusion pressures, can be calculated by describing the relation between arterial blood pressure (ABP) and cerebral oxygen saturation measured by near-infrared spectroscopy (NIRS). In literature, disturbed CAR is described in different patient groups, using multiple measurement techniques and mathematical models. Furthermore, it is unclear to what extent cerebral pathology and outcome can be explained by impaired CAR. Aim and methods: In order to summarize CAR studies using NIRS in neonates, a systematic review was performed in the PUBMED and EMBASE database. To provide a general overview of the clinical framework used to study CAR, the different preprocessing methods and mathematical models are described and explained. Furthermore, patient characteristics, definition of impaired CAR and the outcome according to this definition is described organized for the different patient groups. Results: Forty-six articles were included in this review. Four patient groups were established: preterm infants during the transitional period, neonates receiving specific medication/treatment, neonates with congenital heart disease and neonates with hypoxic-ischemic encephalopathy (HIE) treated with therapeutic hypothermia. Correlation, coherence and transfer function (TF) gain are the mathematical models most frequently used to describe CAR. The definition of impaired CAR is depending on the mathematical model used. The incidence of intraventricular hemorrhage in preterm infants is the outcome variable most frequently correlated with impaired CAR. Hypotension, disease severity, dopamine treatment, injury on magnetic resonance imaging (MRI) and long term outcome are associated with impaired CAR. Prospective interventional studies are lacking in all research areas. Discussion and conclusion: NIRS derived CAR measurement is an important research tool to improve knowledge about central hemodynamic fluctuations during the transitional period, cerebral pharmacodynamics of frequently used medication (sedatives-inotropes) and cerebral effects of specific therapies in neonatology. Uniformity regarding measurement techniques and mathematical models is needed. Multimodal monitoring databases of neonatal intensive care patients of multiple centers, together with identical outcome parameters are needed to compare different techniques and make progress in this field. Real-time bedside monitoring of CAR, together with conventional monitoring, seems a promising technique to improve individual patient care.
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Affiliation(s)
- Liesbeth Thewissen
- Department of Neonatology, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Alexander Caicedo
- Department of Electrical Engineering, ESAT-Stadius, KU Leuven, Leuven, Belgium.,Interuniversity Microelectronics Centre, Leuven, Belgium
| | - Petra Lemmers
- Department of Neonatology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Frank Van Bel
- Department of Neonatology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Sabine Van Huffel
- Department of Electrical Engineering, ESAT-Stadius, KU Leuven, Leuven, Belgium.,Interuniversity Microelectronics Centre, Leuven, Belgium
| | - Gunnar Naulaers
- Department of Neonatology, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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15
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Moerman A, De Hert S. Recent advances in cerebral oximetry. Assessment of cerebral autoregulation with near-infrared spectroscopy: myth or reality? F1000Res 2017; 6:1615. [PMID: 29026526 PMCID: PMC5583743 DOI: 10.12688/f1000research.11351.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2017] [Indexed: 01/12/2023] Open
Abstract
In recent years, the feasibility of near-infrared spectroscopy to continuously assess cerebral autoregulation has gained increasing interest. By plotting cerebral oxygen saturation over blood pressure, clinicians can generate an index of autoregulation: the cerebral oximetry index (COx). Successful integration of this monitoring ability in daily critical care may allow clinicians to tailor blood pressure management to the individual patient's need and might prove to be a major step forward in terms of patient outcome.
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Affiliation(s)
- Anneliese Moerman
- Department of Anesthesiology, Ghent University Hospital, Ghent, Belgium
| | - Stefan De Hert
- Department of Anesthesiology, Ghent University Hospital, Ghent, Belgium
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16
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Kooi EMW, Verhagen EA, Elting JWJ, Czosnyka M, Austin T, Wong FY, Aries MJ. Measuring cerebrovascular autoregulation in preterm infants using near-infrared spectroscopy: an overview of the literature. Expert Rev Neurother 2017. [DOI: 10.1080/14737175.2017.1346472] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Elisabeth M. W. Kooi
- Beatrix Children’s Hospital, Division of Neonatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elise A. Verhagen
- Sophia Children’s Hospital, University of Rotterdam, Erasmus University Hospital, Rotterdam, The Netherlands
| | - Jan Willem J. Elting
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marek Czosnyka
- Department of Academic Neurosurgery, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK
| | - Topun Austin
- Cambridge University Hospitals NHS Foundation Trust, Rosie Hospital, Cambridge, UK
| | - Flora Y. Wong
- Monash Newborn, Monash Medical Centre; Department of Paediatrics, Monash University; The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
| | - Marcel J.H. Aries
- Department of Intensive Care, University of Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
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17
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Caicedo A, Varon C, Alderliesten T, Lemmers P, van Bel F, Naulaers G, Van Huffel S. Differences in the cerebral hemodynamics regulation mechanisms of premature infants with intra-ventricular hemorrhage assessed by means of phase rectified signal averaging. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:4208-11. [PMID: 25570920 DOI: 10.1109/embc.2014.6944552] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Cerebral hemodynamics regulation consists of several mechanisms that try to keep brain homeostasis. In premature infants, due to the immaturity of their cerebral vascular bed, these mechanisms might be impaired exposing their brain to damage. The status of the cerebral regulation mechanism is classically assessed by measuring the coupling between some systemic variables, such as Mean arterial blood pressure (MABP) and concentration of blood gases, with surrogate measurements for cerebral blood flow, such as brain tissue oxygenation (rScO2) measured by means of Near-infrared Spectroscopy. We hypothesized that the coupled dynamics between systemic variables and rScO2 is different in premature infants that suffered from brain damage than in those with a favorable clinical outcome. Therefore, we explore the use of phase rectified signal averaging (PRSA) and bi-variate PRSA (BPRSA) in order to identify these differences. We found that the coupled dynamics between changes in MABP and cerebral oxygenation was different in premature infants that suffered III-IV grade intra-ventricular haemorrhage (IVH), when compared to control subjects.
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18
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Assessment of Cerebral Autoregulation Patterns with Near-infrared Spectroscopy during Pharmacological-induced Pressure Changes. Anesthesiology 2015; 123:327-35. [DOI: 10.1097/aln.0000000000000715] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Abstract
Background:
Previous work has demonstrated paradoxical increases in cerebral oxygen saturation (ScO2) as blood pressure decreases and paradoxical decreases in ScO2 as blood pressure increases. It has been suggested that these paradoxical responses indicate a functional cerebral autoregulation mechanism. Accordingly, the authors hypothesized that if this suggestion is correct, paradoxical responses will occur exclusively in patients with intact cerebral autoregulation.
Methods:
Thirty-four patients undergoing elective cardiac surgery were included. Cerebral autoregulation was assessed with the near-infrared spectroscopy–derived cerebral oximetry index (COx), computed by calculating the Spearman correlation coefficient between mean arterial pressure and ScO2. COx less than 0.30 was previously defined as functional autoregulation. During cardiopulmonary bypass, 20% change in blood pressure was accomplished with the use of nitroprusside for decreasing pressure and phenylephrine for increasing pressure. Effects on COx were assessed. Data were analyzed using two-way ANOVA, Kruskal–Wallis test, and Wilcoxon and Mann–Whitney U test.
Results:
Sixty-five percent of patients had a baseline COx less than 0.30, indicating functional baseline autoregulation. In 50% of these patients (n = 10), COx became highly negative after vasoactive drug administration (from −0.04 [−0.25 to 0.16] to −0.63 [−0.83 to −0.26] after administration of phenylephrine, and from −0.05 [−0.19 to 0.17] to −0.55 [−0.94 to −0.35] after administration of nitroprusside). A negative COx implies a decrease in ScO2 with increase in pressure and, conversely, an increase in ScO2 with decrease in pressure.
Conclusions:
In this study, paradoxical changes in ScO2 after pharmacological-induced pressure changes occurred exclusively in patients with intact cerebral autoregulation, corroborating the hypothesis that these paradoxical responses might be attributable to a functional cerebral autoregulation.
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19
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Eriksen VR, Hahn GH, Greisen G. Cerebral autoregulation in the preterm newborn using near-infrared spectroscopy: a comparison of time-domain and frequency-domain analyses. JOURNAL OF BIOMEDICAL OPTICS 2015; 20:037009. [PMID: 25806662 DOI: 10.1117/1.jbo.20.3.037009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/05/2015] [Indexed: 05/23/2023]
Abstract
The aim was to compare two conventional methods used to describe cerebral autoregulation (CA): frequency-domain analysis and time-domain analysis. We measured cerebral oxygenation (as a surrogate for cerebral blood flow) and mean arterial blood pressure (MAP) in 60 preterm infants. In the frequency domain, outcome variables were coherence and gain, whereas the cerebral oximetry index (COx) and the regression coefficient were the outcome variables in the time domain. Correlation between coherence and COx was poor. The disagreement between the two methods was due to the MAP and cerebral oxygenation signals being in counterphase in three cases. High gain and high coherence may arise spuriously when cerebral oxygenation decreases as MAP increases; hence, time-domain analysis appears to be a more robust—and simpler—method to describe CA.
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Affiliation(s)
- Vibeke R Eriksen
- Copenhagen University Hospital-Rigshospitalet, Department of Neonatology, Blegdamsvej 9, 2100 Copenhagen, DenmarkbUniversity of Copenhagen, Faculty of Health and Medical Sciences, Blegdamsvej 3, Copenhagen, Denmark
| | - Gitte H Hahn
- Copenhagen University Hospital-Rigshospitalet, Department of Neonatology, Blegdamsvej 9, 2100 Copenhagen, DenmarkcCopenhagen University Hospital-Rigshospitalet, Department of Paediatrics and Adolescent Medicine, Blegdamsvej 9, Copenhagen, Denmark
| | - Gorm Greisen
- Copenhagen University Hospital-Rigshospitalet, Department of Neonatology, Blegdamsvej 9, 2100 Copenhagen, Denmark
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20
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Greisen G. Cerebral autoregulation in preterm infants. How to measure it--and why care? J Pediatr 2014; 165:885-6. [PMID: 25152257 DOI: 10.1016/j.jpeds.2014.07.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 07/16/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Gorm Greisen
- Department of Neonatology, Rigshospitalet Copenhagen University, Copenhagen, Denmark.
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21
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Mitra S, Czosnyka M, Smielewski P, O'Reilly H, Brady K, Austin T. Heart rate passivity of cerebral tissue oxygenation is associated with predictors of poor outcome in preterm infants. Acta Paediatr 2014; 103:e374-82. [PMID: 24844816 DOI: 10.1111/apa.12696] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 03/02/2014] [Accepted: 05/15/2014] [Indexed: 11/30/2022]
Abstract
AIM Near-infrared spectroscopy (NIRS) and transcranial Doppler (TCD) allow non-invasive assessment of cerebral haemodynamics. We assessed cerebrovascular reactivity in preterm infants by investigating the relationship between NIRS- and TCD-derived indices and correlating them with severity of clinical illness. METHODS We recorded the NIRS-derived cerebral tissue oxygenation index (TOI) and TCD-derived flow velocity (Fv), along with other physiological variables. Moving correlation coefficients between measurements of cerebral perfusion (TOI, Fv) and heart rate were calculated. We presumed that positivity of these correlation coefficients - tissue oxygenation heart rate reactivity index (TOHRx) and flow velocity heart rate reactivity index (FvHRx) - would indicate a direct relationship between cerebral perfusion and cardiac output representing impaired cerebrovascular autoregulation. RESULTS We studied 31 preterm infants at a median age of 2 days, born at a median gestational age of 26 + 1 weeks. TOHRx was significantly correlated with gestational age (R = -0.57, p = 0.007), birth weight (R = -0.58, p = 0.006) and the Clinical Risk Index for Babies II (R = 0.55, p = 0.0014). TOHRx and FvHRx were significantly correlated (R = 0.39, p = 0.028). CONCLUSION Heart rate has a key influence on cerebral haemodynamics in preterm infants, and TOHRx may be of diagnostic value in identifying impaired cerebrovascular reactivity leading to adverse clinical outcome.
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Affiliation(s)
- S Mitra
- Neonatal Unit; Rosie Hospital; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - M Czosnyka
- Academic Neurosurgical Unit; Department of Neurosurgery; Addenbrooke's Hospital; University of Cambridge; Cambridge UK
| | - P Smielewski
- Academic Neurosurgical Unit; Department of Neurosurgery; Addenbrooke's Hospital; University of Cambridge; Cambridge UK
| | - H O'Reilly
- Neonatal Unit; Norfolk and Norwich University Hospitals NHS Foundation Trust; Norwich UK
| | - K Brady
- Department of Anesthesiology and Critical Care Medicine; John Hopkins University School of Medicine; Baltimore MD USA
| | - T Austin
- Neonatal Unit; Rosie Hospital; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
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22
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Abstract
Controversy surrounds the assessment of perfusion and the methods currently utilised to define hypotension, especially blood pressure. There is growing agreement to assess heart function when selecting inotropic therapy and use bedside tools such as echocardiography for assessing at-risk infants. Both dopamine and dobutamine have comparative efficacy, and in certain disease states with immature myocardium there could be potential advantages in using dobutamine. The concomitant use of hydrocortisone has been shown to be beneficial when escalating doses of first-line inotropes are used. Other inotropes require further study through randomised trials for their safety and efficacy to be established.
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Affiliation(s)
- Samir Gupta
- Department of Paediatrics, University Hospital of North Tees and University of Durham, Stockton-on-Tees, UK.
| | - Steven M Donn
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA
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23
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Caicedo A, Thewissen L, Naulaers G, Lemmers P, van Bel F, Van Huffel S. Effect of maternal use of labetalol on the cerebral autoregulation in premature infants. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2013; 789:105-111. [PMID: 23852483 DOI: 10.1007/978-1-4614-7411-1_15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Hypertensive disorders of pregnancy (HDP) are normally treated to avoid maternal complications. In this study we aimed to investigate if there was an effect of maternal HDP treatment on the cerebral autoregulation of the neonates by analysing measurements of mean arterial blood pressure (MABP) and rScO2 by means of correlation, coherence, and transfer function analysis. We found that these infants presented higher values of transfer function gain, which indicates impaired cerebral autoregulation, with a decreasing trend towards normality. We hypothesised that this trend was due to a vasodilation effect of the maternal use of labetalol due to accumulation, which disappeared by the third day after birth. Therefore, we investigated the values of pulse pressure in order to find evidence for a vasodilatory effect. We found that lower values of pulse pressure were present in these infants when compared with a control population, which, together with increased transfer function gain values, suggests an effect of the drug on the cerebral autoregulation.
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Affiliation(s)
- Alexander Caicedo
- Department of Electrical Engineering, ESAT/SCD, KU Leuven, Leuven, Belgium. .,iMinds Future Health Department, Leuven, Belgium.
| | - Liesbeth Thewissen
- Neonatal Intensive Care Unit, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Gunnar Naulaers
- Neonatal Intensive Care Unit, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Petra Lemmers
- Department of Neonatology, University Medical Center, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Frank van Bel
- Department of Neonatology, University Medical Center, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Sabine Van Huffel
- Department of Electrical Engineering, ESAT/SCD, KU Leuven, Leuven, Belgium.,iMinds Future Health Department, Leuven, Belgium
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