Association between cerebral oxygen saturation and brain injury in neonates receiving therapeutic hypothermia for neonatal encephalopathy

Szakmár, Enikő; Smith, Jennifer E.; Yang, Edward; Volpe, Joseph J.; Inder, Terrie E.; El‐Dib, Mohamed

doi:10.1038/s41372-020-00910-w

Cited by 16 publications

(19 citation statements)

References 33 publications

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“…Importantly, the degree of hyperperfusion was associated with the severity of injury and subsequently increased risk of adverse neurodevelopmental outcomes ( 34 , 35 ). An increase in cerebral oxygen saturation during hypothermia and rewarming was also associated with injury severity ( 36 ). However, variable predictive ability was seen in these small observational studies ( 37 ).…”

Section: Introductionmentioning

confidence: 99%

“…Importantly, several studies have reported a trend for increasing cerebral oxygenation during hypothermia and rewarming to be associated with adverse neurodevelopmental outcomes, compared to stable oxygenation values in neonates with normal MRI findings ( 36 , 38 ). This suggests that continuous monitoring with NIRS may still offer useful predictive value despite high inter-individual variability.…”

Section: Introductionmentioning

confidence: 99%

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Cerebral Oxygenation and Metabolism After Hypoxia-Ischemia

et al. 2022

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Perinatal hypoxia-ischemia (HI) is still a significant contributor to mortality and adverse neurodevelopmental outcomes in term and preterm infants. HI brain injury evolves over hours to days, and involves complex interactions between the endogenous protective and pathological processes. Understanding the timing of evolution of injury is vital to guide treatment. Post-HI recovery is associated with a typical neurophysiological profile, with stereotypic changes in cerebral perfusion and oxygenation. After the initial recovery, there is a delayed, prolonged reduction in cerebral perfusion related to metabolic suppression, followed by secondary deterioration with hyperperfusion and increased cerebral oxygenation, associated with altered neurovascular coupling and impaired cerebral autoregulation. These changes in cerebral perfusion are associated with the stages of evolution of injury and injury severity. Further, iatrogenic factors can also affect cerebral oxygenation during the early period of deranged metabolism, and improving clinical management may improve neuroprotection. We will review recent evidence that changes in cerebral oxygenation and metabolism after HI may be useful biomarkers of prognosis.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cerebral Oxygenation and Metabolism After Hypoxia-Ischemia

et al. 2022

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“…This difference between groups was especially prominent during the first 10 h of hypothermia treatment suggesting an early predictive ability for later outcome using this biomarker (44). Further studies during TH have found that higher absolute cerebral tissue oxygen saturation (CrSO 2, SctO 2 ) between 24 and 36h after birth (43,45,46) and rewarming (46) predicted adverse neurological outcome as measured by moderate to severe injury on MRI (Figure 3) (45). Rate of rise of CrSO 2 from baseline until 36 h was also significant in differentiating between outcome groups on MRI (45).…”

Section: Monitoring Absolute Cerebral Tissue Oxygen Saturationmentioning

confidence: 93%

“…By combining both parameters at 24 h, the ability to predict adverse neurological outcome on MRI between 7 and 14 d after birth was significant with a sensitivity and specificity of 100% (38). Subsequently, several clinical studies in NE over the period of TH and re-warming have found significant differences in the absolute cerebral tissue oxygen saturation values between favorable and adverse outcome groups as determined by MRI or neurodevelopmental follow up (39)(40)(41)(42)(43)(44)(45)(46). Cerebral oximetry monitoring commenced within 6 h after birth in one study of cooled infants found absolute cerebral tissue oxygen saturation (rSO 2 ) fell following the onset of cooling in all infants followed by a gradual rise then plateau by ∼24 h. rSO 2 significantly increased from day 1 to day 2 of life in both outcome groups but was consistently higher throughout the 72 h hypothermia treatment in asphyxiated newborns developing later brain injury when compared to those with favorable outcomes.…”

Section: Monitoring Absolute Cerebral Tissue Oxygen Saturationmentioning

confidence: 99%

Role of Optical Neuromonitoring in Neonatal Encephalopathy—Current State and Recent Advances

et al. 2021

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Neonatal encephalopathy (NE) in term and near-term infants is a significant global health problem; the worldwide burden of disease remains high despite the introduction of therapeutic hypothermia. Assessment of injury severity and effective management in the neonatal intensive care unit (NICU) relies on multiple monitoring modalities from systemic to brain-specific. Current neuromonitoring tools provide information utilized for seizure management, injury stratification, and prognostication, whilst systemic monitoring ensures multi-organ dysfunction is recognized early and supported wherever needed. The neuromonitoring technologies currently used in NE however, have limitations in either their availability during the active treatment window or their reliability to prognosticate and stratify injury confidently in the early period following insult. There is therefore a real need for a neuromonitoring tool that provides cot side, early and continuous monitoring of brain health which can reliably stratify injury severity, monitor response to current and emerging treatments, and prognosticate outcome. The clinical use of near-infrared spectroscopy (NIRS) technology has increased in recent years. Research studies within this population have also increased, alongside the development of both instrumentation and signal processing techniques. Increasing use of commercially available cerebral oximeters in the NICU, and the introduction of advanced optical measurements using broadband NIRS (BNIRS), frequency domain NIRS (FDNIRS), and diffuse correlation spectroscopy (DCS) have widened the scope by allowing the direct monitoring of oxygen metabolism and cerebral blood flow, both key to understanding pathophysiological changes and predicting outcome in NE. This review discusses the role of optical neuromonitoring in NE and why this modality may provide the next significant piece of the puzzle toward understanding the real time state of the injured newborn brain.

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“…Several studies have examined cerebral NIRS measures during therapeutic hypothermia as a predictor for both adverse brain MRI outcomes and longer-term neurodevelopmental outcomes. High rScO2 and low fTOE are associated with worse neuroimaging outcomes by MRI in several small studies ( 44 – 47 ). A high rScO2 may indicate that cerebral blood flow occurs in excess of the need for oxygen utilization (luxury perfusion).…”

Section: Near Infrared Spectroscopy (Nirs)mentioning

confidence: 97%

Optimal neuromonitoring techniques in neonates with hypoxic ischemic encephalopathy

Chock

Rao²,

Meurs³

2023

Front. Pediatr.

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Neonates with hypoxic ischemic encephalopathy (HIE) are at significant risk for adverse outcomes including death and neurodevelopmental impairment. Neuromonitoring provides critical diagnostic and prognostic information for these infants. Modalities providing continuous monitoring include continuous electroencephalography (cEEG), amplitude-integrated electroencephalography (aEEG), near-infrared spectroscopy (NIRS), and heart rate variability. Serial bedside neuromonitoring techniques include cranial ultrasound and somatic and visual evoked potentials but may be limited by discrete time points of assessment. EEG, aEEG, and NIRS provide distinct and complementary information about cerebral function and oxygen utilization. Integrated use of these neuromonitoring modalities in addition to other potential techniques such as heart rate variability may best predict imaging outcomes and longer-term neurodevelopment. This review examines available bedside neuromonitoring techniques for the neonate with HIE in the context of therapeutic hypothermia.

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Association between cerebral oxygen saturation and brain injury in neonates receiving therapeutic hypothermia for neonatal encephalopathy

Cited by 16 publications

References 33 publications

Cerebral Oxygenation and Metabolism After Hypoxia-Ischemia

Cerebral Oxygenation and Metabolism After Hypoxia-Ischemia

Role of Optical Neuromonitoring in Neonatal Encephalopathy—Current State and Recent Advances

Optimal neuromonitoring techniques in neonates with hypoxic ischemic encephalopathy

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