Brain perfusion in encephalopathic newborns after therapeutic hypothermia.

MedStar author(s):
Citation: Ajnr: American Journal of Neuroradiology. 34(8):1649-55, 2013 Aug.PMID: 23493898Institution: MedStar Washington Hospital CenterDepartment: Neonatology and PediatricsForm of publication: Journal ArticleMedline article type(s): Journal Article | Randomized Controlled Trial | Research Support, N.I.H., Extramural | Research Support, Non-U.S. Gov'tSubject headings: *Brain/pa [Pathology] | *Brain/pp [Physiopathology] | *Cerebrovascular Circulation | *Hypothermia, Induced/mt [Methods] | *Hypoxia-Ischemia, Brain/pp [Physiopathology] | *Hypoxia-Ischemia, Brain/th [Therapy] | Blood Flow Velocity | Female | Humans | Hypoxia-Ischemia, Brain/pa [Pathology] | Infant, Newborn | Male | Reproducibility of Results | Sensitivity and Specificity | Treatment OutcomeYear: 2013Local holdings: Available online from MWHC library: 1995 - present (after 18 months)ISSN:
  • 0195-6108
Name of journal: AJNR. American journal of neuroradiologyAbstract: BACKGROUND AND PURPOSE: Cerebral perfusion patterns in neonates with HIE after therapeutic hypothermia have not been well described. The objectives of this study were to compare global and regional perfusion between infants with HIE and neonate controls and to relate measures of cerebral perfusion to brain injury on conventional MR imaging in neonates with HIE.CONCLUSIONS: Disturbed cerebral perfusion is observed in the second week of life in some babies with HIE despite treatment with hypothermia. Infants with HIE with injury on MR imaging have lower regional CBF in the thalamus compared with those without injury, possibly representing pseudonormalization of CBF and low metabolic demand after progression to irreversible brain injury.MATERIALS AND METHODS: Term encephalopathic neonates meeting criteria for hypothermia between June 2011 and January 2012 were enrolled in this prospective observational study. MR imaging-ASL was performed in the second week of life. Comparisons were made with data from neonate controls who underwent the same imaging protocol. NIRS measures of cerebral oxygenation during and immediately after hypothermia were also evaluated in a subset of patients. Secondary analyses were performed to assess cerebral perfusion and oxygenation differences by pattern of injury on qualitative MR imaging interpretation.RESULTS: We enrolled 18 infants with HIE and 18 control infants. Mean global CBF and regional CBF in the basal ganglia, thalamus, and anterior white matter were higher in cases compared with controls. Infants with HIE with injury on MR imaging, however, had lower CBF (significant in the thalamus) compared with those with normal MR imaging. Decreased FTOE by NIRS further differentiated patients with HIE with injury on MR imaging.All authors: Bouyssi-Kobar M, Chang T, du Plessis AJ, Limperopoulos C, Massaro AN, Vezina LGFiscal year: FY2014Digital Object Identifier: Date added to catalog: 2014-04-04
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 23493898 Available 23493898

Available online from MWHC library: 1995 - present (after 18 months)

BACKGROUND AND PURPOSE: Cerebral perfusion patterns in neonates with HIE after therapeutic hypothermia have not been well described. The objectives of this study were to compare global and regional perfusion between infants with HIE and neonate controls and to relate measures of cerebral perfusion to brain injury on conventional MR imaging in neonates with HIE.

CONCLUSIONS: Disturbed cerebral perfusion is observed in the second week of life in some babies with HIE despite treatment with hypothermia. Infants with HIE with injury on MR imaging have lower regional CBF in the thalamus compared with those without injury, possibly representing pseudonormalization of CBF and low metabolic demand after progression to irreversible brain injury.

MATERIALS AND METHODS: Term encephalopathic neonates meeting criteria for hypothermia between June 2011 and January 2012 were enrolled in this prospective observational study. MR imaging-ASL was performed in the second week of life. Comparisons were made with data from neonate controls who underwent the same imaging protocol. NIRS measures of cerebral oxygenation during and immediately after hypothermia were also evaluated in a subset of patients. Secondary analyses were performed to assess cerebral perfusion and oxygenation differences by pattern of injury on qualitative MR imaging interpretation.

RESULTS: We enrolled 18 infants with HIE and 18 control infants. Mean global CBF and regional CBF in the basal ganglia, thalamus, and anterior white matter were higher in cases compared with controls. Infants with HIE with injury on MR imaging, however, had lower CBF (significant in the thalamus) compared with those with normal MR imaging. Decreased FTOE by NIRS further differentiated patients with HIE with injury on MR imaging.

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