Abstract
Neurologic morbidity remains high in neonates with perinatal hypoxic-ischemic injury despite therapeutic hypothermia. DTI provides qualitative and quantitative information about the microstructure of the brain, and a near-infrared spectroscopy index can assess cerebrovascular autoregulation. We hypothesized that lower ADC values would correlate with worse autoregulatory function. Thirty-one neonates with hypoxic-ischemic injury were enrolled. ADC scalars were measured in 27 neonates (age range, 4-15 days) in the anterior and posterior centrum semiovale, basal ganglia, thalamus, posterior limb of the internal capsule, pons, and middle cerebellar peduncle on MRI obtained after completion of therapeutic hypothermia. The blood pressure range of each neonate with the most robust autoregulation was identified by using a near-infrared spectroscopy index. Autoregulatory function was measured by blood pressure deviation below the range with optimal autoregulation. In neonates who had MRI on day of life ≥10, lower ADC scalars in the posterior centrum semiovale (r = -0.87, P = .003, n = 9) and the posterior limb of the internal capsule (r = -0.68, P = .04, n = 9) correlated with blood pressure deviation below the range with optimal autoregulation during hypothermia. Lower ADC scalars in the basal ganglia correlated with worse autoregulation during rewarming (r = -0.71, P = .05, n = 8). Blood pressure deviation from the optimal autoregulatory range may be an early biomarker of injury in the posterior centrum semiovale, posterior limb of the internal capsule, and basal ganglia. Optimizing blood pressure to support autoregulation may decrease the risk of brain injury in cooled neonates with hypoxic-ischemic injury.
Highlights
MethodsADC scalars were measured in 27 neonates (age range, 4 –15 days) in the anterior and posterior centrum semiovale, basal ganglia, thalamus, posterior limb of the internal capsule, pons, and middle cerebellar peduncle on MRI obtained after completion of therapeutic hypothermia
BACKGROUND AND PURPOSENeurologic morbidity remains high in neonates with perinatal hypoxic-ischemic injury despite therapeutic hypothermia
In neonates who had MRI on day of life Ն10, lower ADC scalars in the posterior centrum semiovale (r ϭ Ϫ0.87, P ϭ .003, n ϭ 9) and the posterior limb of the internal capsule (r ϭ Ϫ0.68, P ϭ .04, n ϭ 9) correlated with blood pressure deviation below the range with optimal autoregulation during hypothermia
Summary
ADC scalars were measured in 27 neonates (age range, 4 –15 days) in the anterior and posterior centrum semiovale, basal ganglia, thalamus, posterior limb of the internal capsule, pons, and middle cerebellar peduncle on MRI obtained after completion of therapeutic hypothermia. The blood pressure range of each neonate with the most robust autoregulation was identified by using a near-infrared spectroscopy index. Autoregulatory function was measured by blood pressure deviation below the range with optimal autoregulation. Nearterm and term neonates (35 gestational weeks and later) with moderate or severe HII were prospectively enrolled for 27 months, after obtaining written informed consent from the parents. Criteria for HII were based on the clinical trial of hypothermia in HII of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.[3] All enrolled neonates had moderate-to-severe encephalopathy. Exclusion criteria were lack of an arterial blood pressure catheter, congenital anomalies that make cooling unsafe, or coagulopathy with active bleeding
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