A Novel Approach to Quantification of Cerebrovascular Function in Newborns
- Children’s Medical Center (Dallas, Plano, Southlake)
- Parkland Health & Hospital System
Lina Chalak, M.D.
Pathophysiologic mechanisms involved in hypoxic ne are associated with complex changes in cerebral blood flow and metabolism. Therapeutic hypothermia is effective in reducing the extent of brain injury, but it remains uncertain how hypothermia affects autoregulation and neurovascular coupling. Preliminary observations challenge the existing paradigm of a purely passive circulation in hypoxic ne and demonstrate the need to develop a non-invasive strategy to quantify dynamic autoregulation and link it to outcomes. new knowledge gained from the completion of this project will improve the understanding of the underlying pathophysiology and will specifically provide: 1) a quantitative method to assess dysfunctional regulation and individual cerebral metabolic responses to therapy, 2) a new understanding of the relationship of changes in cerebral perfusion to neuronal activity, and 3) a discovery of combined hemodynamic parameters which have the potential to serve as bedside biomarkers of treatment response and optimization. once theses measures are evaluated, we will evaluate cerebrovascular function and neurovascular coupling in hypoxic ne in conjunction with new trials of neuroprotection. Future trials will extend to the study of cerebrovascular function across gestational age (Ga) to better understand the pathophysiology of intraventricular hemorrhage in preterm neonates.
-newborns >/= 36 weeks gestational age
-newborn has history of an acute perinatal event (e.g., abruption placenta, cord prolapse, decreased fetal heart rate)
-umbilical cord arterial pH or arterial blood gas at <1 hour postnatal age of = 7.0 or base deficit >/= 16 mEq/L
-neurological examination performed by certified examiner that classifies the encephalopathy as none, mild, moderate, or severe according to the NICHD scoring within 6 hours of birth
-must have indwelling arterial umbilical line