New Wavelet Neurovascular Bundle for Bedside Evaluation of Cerebral Autoregulation and Neurovascular Coupling in Newborns with Hypoxic-Ischemic Encephalopathy
New Wavelet Neurovascular Bundle for Bedside Evaluation of Cerebral Autoregulation and Neurovascular Coupling in Newborns with Hypoxic-Ischemic Encephalopathy
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DOI：
10.1159/000457833
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发表时间：
2017-01-01
影响因子：
2.9
通讯作者：
Zhang, Rong
中科院分区：
文献类型：
--
作者：
Chalak, Lina F.;Zhang, Rong
出生窒息引起的新生儿脑病（NE）每年对数百万婴儿构成主要的全球公共卫生负担，尽管进行了低温治疗，但其中一半的新生儿神经系统结局不佳。随着新的神经保护干预措施正在临床试验中进行研究，迫切需要建立治疗效果的生理替代标志物，以指导患者选择和/或修改治疗干预措施。新生儿脑损伤领域面临的挑战是难以在出生后的短时间内在临床上辨别 NE 严重程度或分析患病 NE 新生儿脑循环的动态方面。为了解决这个障碍，我们最近开发了一种新的“小波神经血管束”分析系统，可以在动态、非平稳的临床条件下在多个时间尺度上测量大脑自动调节（CA）和神经血管耦合（NVC）。这种小波分析可以允许在床边对患有脑病的新生儿进行（1）CA（结合血压和脑近红外光谱，NIRS 的指标）和（2）NVC（结合从 NIRS 和 EEG 获得的指标）的床边无创量化，而无需线性和静态系统的数学假设。在这篇概念论文中，我们展示了使用 CA 和 NVC 生理小波度量的 NE 案例。这种新方法一旦在大型 NE 研究中得到验证，就有可能优化治疗决策候选者的选择以及神经认知结果的预测。(C) 2017 S. Karger AG，巴塞尔
Neonatal encephalopathy (NE) resulting from birth asphyxia constitutes a major global public health burden for millions of infants every year, and despite therapeutic hypothermia, half of these neonates have poor neurological outcomes. As new neuroprotective interventions are being studied in clinical trials, there is a critical need to establish physiological surrogate markers of therapeutic efficacy, to guide patient selection and/or to modify the therapeutic intervention. The challenge in the field of neonatal brain injury has been the difficulty of clinically discerning NE severity within the short therapeutic window after birth or of analyzing the dynamic aspects of the cerebral circulation in sick NE newborns. To address this roadblock, we have recently developed a new "wavelet neurovascular bundle" analytical system that can measure cerebral autoregulation (CA) and neurovascular coupling (NVC) at multiple time scales under dynamic, nonstationary clinical conditions. This wavelet analysis may allow noninvasive quantification at the bedside of (1) CA (combining metrics of blood pressure and cerebral near-infrared spectroscopy, NIRS) and (2) NVC (combining metrics obtained from NIRS and EEG) in newborns with encephalopathy without mathematical assumptions of linear and stationary systems. In this concept paper, we present case examples of NE using the proposed physiological wavelet metrics of CA and NVC. The new approach, once validated in large NE studies, has the potential to optimize the selection of candidates for therapeutic decision-making, and the prediction of neurocognitive out-comes.(C) 2017 S. Karger AG, Basel