New Time-Frequency Method for Cerebral Autoregulation in Newborns: Predictive Capacity for Clinical Outcomes

Riera, Joan; Cabañas, Fernando; Olmedo, José Javier Serrano; Bravo, María Carmen; López-Ortego, Paloma; Sánchez, Laura; Madero, Rosário; Pellicer, Adelina

doi:10.1016/j.jpeds.2014.06.008

Cited by 32 publications

(29 citation statements)

References 19 publications

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“…It is unclear whether there is a developmental aspect during the first minutes and/or hours of life. The present study shows that cerebral autoregulation might be impaired in preterm infants during immediate transition [23,24]. …”

Section: Discussionmentioning

confidence: 99%

Blood Pressure during the Immediate Neonatal Transition: Is the Mean Arterial Blood Pressure Relevant for the Cerebral Regional Oxygenation?

et al. 2017

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Background: Measurement of mean arterial blood pressure (MABP) is feasible during neonatal transition. Objective: The objective of this study was to investigate a potential influence of MABP on the cerebral regional oxygen saturation (crSO₂) in preterm and term infants during the immediate neonatal transition. Materials and Methods: Preterm and term infants were included in this observational study. The crSO₂ was measured by near-infrared spectroscopy with the INVOS 5100C (Somanetics Corp., Troy, MI, USA) during the immediate neonatal transition (15 min after birth). The near-infrared spectroscopy sensor was applied to the left forehead. Furthermore, a pulse oximeter was applied to monitor arterial oxygen saturation (SpO₂) and heart rate (HR). Fifteen minutes after birth, blood pressure was measured noninvasively at the left upper arm. Cerebral fraction tissue oxygen extraction (cFTOE) was calculated from SpO₂ and crSO₂. To investigate a potential association between crSO₂/cFTOE and MABP, we performed a correlation analysis. Results: A total of 462 preterm and term infants (186/292) were included. Mean gestational age was 31.0 ± 3.5 weeks for preterm infants and 38.9 ± 0.8 weeks for full term infants. Mean birth weight was 1.591 ± 630 g in preterm infants and 3.331 ± 461 g in term infants. There was a significant negative correlation between MABP and cFTOE (ρ = -0.19, p = 0.03) in preterm infants but not in term infants (ρ = 0.05, p = 0.39). There was no significant correlation between MABP and crSO₂ in either group. Conclusion: MABP has an impact on cerebral oxygenation in preterm infants. Therefore, blood pressure monitoring during the immediate neonatal transition might be relevant for improving cerebral oxygenation especially in preterm infants.

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Section: Discussionmentioning

confidence: 99%

Blood Pressure during the Immediate Neonatal Transition: Is the Mean Arterial Blood Pressure Relevant for the Cerebral Regional Oxygenation?

et al. 2017

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“…We recently described a new time-frequency domain method to analyze the relationship between two biological signals: bivariate autoregressive spectral coherence (BiAR-COH) (2). This method, which assesses the cerebral autoregulation capacity of preterm infants, notably improved our ability to predict the classification of infants at risk of poor perfusion states when compared with other spectral coherence methods (COH) (3,4).…”

mentioning

confidence: 99%

New developments in cerebral blood flow autoregulation analysis in preterm infants: a mechanistic approach

Riera

Cabañas

Olmedo³

et al. 2015

Pediatr Res

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Background: Impaired autoregulation capacity implies that changes in cerebral perfusion follow changes in blood pressure; however, no analytical method has explored such a signal causality relationship in infants. We sought to develop a method to assess cerebral autoregulation from a mechanistic point of view and explored the predictive capacity of the method to classify infants at risk for adverse outcomes. Methods: The partial directed coherence (PDC) method, which considers synchronicity and directionality of signal dependence across frequencies, was used to analyze the relationship between spontaneous changes in mean arterial pressure (MAP) and the cerebral tissue oxygenation index (TOI). PDC MAP>>TOI indicated that changes in TOI were induced by MAP changes, and PDC TOI>>MAP indicated the opposite. results: The PDC MAP>>TOI and PDC TOI>>MAP values differed. PDC MAP>>TOI adjusted by gestational age predicted low superior vena cava flow (≤41 ml/kg per min), with an area under the receiver operating characteristic curve of 0.72 (95% CI: 0.63-0.81; P < 0.001), whereas PDC TOI>>MAP did not. The adjusted pPDC MAP>>TOI (the average value per patient) predicted severe intracranial hemorrhage and mortality. conclusion: PDC MAP>>TOI allows for a noninvasive physiological interpretation of the pressure autoregulation process in neonates. PDC MAP>>TOI is a good classifier for infants at risk of brain hypoperfusion and adverse outcomes.

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“…Clinical factors related to impaired cerebrovascular autoregulation are lower gestational age (GA) [29,34,35], lower birth weight (BW), lower glucose levels [29,34,36], higher clinical risk index for babies (CRIB) score [34], increased infant mortality [34,37], and higher PaCO 2 levels [15,38,39]. Perinatal risk factors such as pregnancy induced hypertension; antepartum hemorrhage and placental infarction are also associated with impaired cerebrovascular autoregulation [29].…”

Section: Clinical Factorsmentioning

confidence: 99%

“…Hahn et al mathematically calculated coherence thresholds for various MABP levels, using complex mathematical Monte Carlo simulations, resulting in coherence scores for autoregulation impairment to be >0.47 in the verylow-frequency range and >0.45 in the low-frequency range [58]. Riera et al measured superior vena cave (SVC) flow and found that infants with coherence values between MABP and TOI >0.52 had lower SVC flow [37]. A possible explanation to this finding may be that below the lower ABP threshold for autoregulation, a reduced CBF and subsequently reduced SVC flow occur [68].…”

Section: Thresholds For Coherencementioning

confidence: 99%

“…They therefore introduced a new prediction model, the bivariate autoregressive spectral coherence (BiAR-COH) method, to predict cerebral oxygenation changes in relationship to MABP changes from previous samples in the very-low-frequency range. They showed that this model was superior to the simple TFA coherence method for predicting low SVC flow or adverse outcome in 54 preterm infants [37].…”

Section: Other Autoregulation Modelsmentioning

confidence: 99%

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Measuring cerebrovascular autoregulation in preterm infants using near-infrared spectroscopy: an overview of the literature

Kooi¹,

Verhagen

Elting

et al. 2017

Expert Review of Neurotherapeutics

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(2017) Measuring cerebrovascular autoregulation in preterm infants using near-infrared spectroscopy: an overview of the literature, Expert Review of Neurotherapeutics, 17:8, 801-818, DOI: 10.1080/14737175.2017 Introduction:The preterm born infant's ability to regulate its cerebral blood flow (CBF) is crucial in preventing secondary ischemic and hemorrhagic damage in the developing brain. The relationship between arterial blood pressure (ABP) and CBF estimates, such as regional cerebral oxygenation as measured by near-infrared spectroscopy (NIRS), is an attractive option for continuous non-invasive assessment of cerebrovascular autoregulation. Areas covered: The authors performed a literature search to provide an overview of the current literature on various current clinical practices and methods to measure cerebrovascular autoregulation in the preterm infant by NIRS. The authors focused on various aspects: Characteristics of patient cohorts, surrogate measures for cerebral perfusion pressure, NIRS devices and their accompanying parameters, definitions for impaired cerebrovascular autoregulation, methods of measurements and clinical implications. Expert commentary: Autoregulation research in preterm infants has reported many methods for measuring autoregulation using different mathematical models, signal processing and data requirements. At present, it remains unclear which NIRS signals and algorithms should be used that result in the most accurate and clinically relevant assessment of cerebrovascular autoregulation. Future studies should focus on optimizing strategies for cerebrovascular autoregulation assessment in preterm infants in order to develop autoregulation-based cerebral perfusion treatment strategies. ARTICLE HISTORY

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New Time-Frequency Method for Cerebral Autoregulation in Newborns: Predictive Capacity for Clinical Outcomes

Cited by 32 publications

References 19 publications

Blood Pressure during the Immediate Neonatal Transition: Is the Mean Arterial Blood Pressure Relevant for the Cerebral Regional Oxygenation?

Blood Pressure during the Immediate Neonatal Transition: Is the Mean Arterial Blood Pressure Relevant for the Cerebral Regional Oxygenation?

New developments in cerebral blood flow autoregulation analysis in preterm infants: a mechanistic approach

Measuring cerebrovascular autoregulation in preterm infants using near-infrared spectroscopy: an overview of the literature

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