Abstract
Intiduction. Perinatal hypoxic ischemic encephalopathy (HIE) is associated with approximately one-quarter of global neonatal deaths. Dysregulated cerebral blood flow may be a key component for secondary neurologic injury in HIE. The load of fluids to increase intravascular volume is the point of care in infants because the cerebral blood flow in neonatal period depends mainly on the cardiac output but the choice of fluids is still debatable.Objective. To determine the impact of 6% hydroxyethyl starch (HES) 130/0.42 in a balanced crystalloid solution on brain perfusion in term neonates with severe hypoxic-ischemic encephalopathy.Materials and methods. Single-center, prospective, simple, randomized controlled study was performed in 205 full-term infants with hypoxic-ischemic encephalopathy grade II and grade III by Sarnat score in the period of 2012-2016. Depending on fluids for volume resuscitation, all infants were randomly divided into HES and control groups. In HES group 45 term infants with moderate to severe hypoxic-ischemic encephalopathy were treated at the 1st DOL with 6% hydroxyethyl starch (HES) 130/0.42 in a balanced crystalloid solution at a dose of 10 ml/kg. The control group included 160 term neonates with hypoxic-ischemic encephalopathy undergoing routine intensive care with normal saline at a dose of 20 ml/kg as the loading volume if needed. To assess the impact of 6% HES on systemic and cerebral hemodynamics, such criteria as mean blood pressure (MBP) and transfontanel Doppler indices RI, PI and CPP were obtained at the 1st, 2nd and 3rd DOL.Results. Using of 6% HES 130/0.42 at the dose of 10 ml/kg of body weight for volume replacement in neonates with moderate to severe HIE at the 1st DOL led to increasing of Resistive Index (RI) in front cerebral artery 2nd DOL (p = 0.025) and 3rd DOL (p = 0.023).Conclusion. Administration of 6% HES 130/0.42 in a balanced crystalloid solution in term newborns with severe hypoxic-ischemic encephalopathy for volume resuscitation results in significant improvement of cerebral blood flow, specifically increasing of Doppler Resistive Index in front cerebral arteries.
Highlights
Perinatal hypoxic ischemic encephalopathy (HIE) is associated with approximately one-quarter of global neonatal deaths
Using of 6% HES 130/0.42 at the dose of 10 ml/kg of body weight for volume replacement in neonates with moderate to severe HIE at the 1st DOL led to increasing of Resistive Index (RI) in front cerebral artery 2nd DOL (p = 0.025) and 3rd DOL (p = 0.023)
All the babies were treated using mild therapeutic hypothermia 33-35 °C for 72 hours, assisted positive-pressure ventilation under routine control of acid-base balance, monitoring of SpO2 and etCO2, control of systemic hemodynamics (heart rate, mean blood pressure (MBP), cardiac output), the estimation of consciousness by modified GCS [10], cerebral hemodynamic evaluation by non-invasive method based on conventional ultrasound Doppler transfontanel measurement of blood flow in the front cerebral artery (Arteria Cerebri Anterior, ACA) with estimation of systolic (Vs), diastolic (Vd), mean velocity (Vm) and calculation of Pourcelot
Summary
Perinatal hypoxic ischemic encephalopathy (HIE) is associated with approximately one-quarter of global neonatal deaths. In 2010, there were an estimated 1.15 million cases of neonatal encephalopathy, of which 96% of were from low- and middle-income countries [23]. Cerebrovascular autoregulation maintains relatively constant cerebral blood flow across changes in perfusion pressure. The load of fluids to increase intravascular volume is the point of carein infants becauseunlike adults the cerebral blood flow in neonates depends mainly on the cardiac output than blood pressure [11] but the choice of fluids is still debatable.the safety of HES 6% in newborns seems quite proven [16, 22], its efficacy as a fluid for volume replacement in the acute period of severe hypoxic-ischemic encephalopathy remains discussible
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