Neuroprotection of the Perinatal Brain by Early Information of Cerebral Oxygenation and Perfusion Patterns

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.

The combination of Astragalus membranaceus and ligustrazine mitigates cerebral ischemia‐reperfusion injury via regulating NR2B‐ERK/CREB signaling

“…Primary rat cerebral cortical neurons were isolated from a timed‐pregnancy embryonic day 14–16 Sprague Dawley rat pups, as previously described (Costa et al., 2021 ). Briefly, pregnant rats were anesthetized with 3% isoflurane and then pups were taken out of the embryo and euthanized by excessive injection of pentobarbital sodium (150 mg/kg).…”

“…Cerebral ischemia‐reperfusion (I/R) injury is a pathophysiological cascade that can lead to brain injury and tissue deterioration, which compromises the beneficial effect of recanalization (Costa et al., 2021 ). Ischemic tissue reperfusion can cause increased reactive oxygen species (ROS), inflammation, necrosis and apoptosis, which aggravate the injury and worsen the prognosis of patients (Guan et al., 2019 ).…”

A Review of Monitoring Methods for Cerebral Blood Oxygen Saturation

“…Comparative analysis revealed that rSO 2 monitoring can provide real-time trend information regarding cerebral oxygenation under aortic occlusion. rSO 2 monitoring is highly important for understanding the health conditions of infants and young children [ 80 ]. Early treatment should be administered if cerebral ischemia and hypoxia are discovered so as to prevent further aggravation and unnecessary burden.…”

The utility of therapeutic hypothermia on cerebral autoregulation

“…[ 102 ] To date, hypothermia to 33.5°C for 72 h is the only established treatment for reducing reperfusion injury after birth asphyxia. [ 103 ]…”