Later cooling within 6 h and temperatures outside 33-34 °C are not associated with dysfunctional autoregulation during hypothermia for neonatal encephalopathy.
Later cooling within 6 h and temperatures outside 33-34 °C are not associated with dysfunctional autoregulation during hypothermia for neonatal encephalopathy.
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DOI：
10.1038/s41390-020-0876-8
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发表时间：
2021-01
影响因子：
3.6
通讯作者：
Lee JK
中科院分区：
文献类型：
--
作者：
Gilmore MM;Tekes A;Perin J;Parkinson C;Spahic H;Chavez-Valdez R;Northington FJ;Lee JK
降温延迟、温度在33-34°C之外、血压低于平均动脉压和最佳脑自动调节(MAPOPT)可能会削弱治疗低温对新生儿缺氧缺血性脑病(HIE)的神经保护作用。我们假设，达到34摄氏度的温度且温度低于33-34摄氏度的时间越长，自我调节能力就越差，大脑损伤就越严重。对63例HIE患儿在低温(n=63)和复温(n=58)时进行直肠温度和近红外光谱自动调节监测。所有患者均接受了脑MRI检查，其中一组患者在第10天前接受了磁共振扩散张量成像(n=41)。大多数新生儿在出生后3-6小时达到34℃。MAPOPT在低温组为54/63(86%)，复温组为53/58(91%)。降温时间与血压偏离MAPOPT无关。晚期降温与单侧半卵圆后半卵圆后区ADC标量降低有关，而与其他区域无关。34℃以上的温度与MAPOPT以上的血压有关，但与脑损伤无关。在3h后主要降温的新生儿中，降温时间与自我调节或整体脑损伤无关。MAPOPT以上的血压偏差与34°C以上的温度有关，还需要在更具异质性的人群中进行进一步的研究。
Cooling delays, temperature outside 33–34°C, and blood pressure below the mean arterial blood pressure with optimal cerebral autoregulation (MAPOPT) might diminish neuroprotection from therapeutic hypothermia in neonates with hypoxic-ischemic encephalopathy (HIE). We hypothesized that longer time to reach temperature <34°C and having temperature outside 33–34°C would be associated with worse autoregulation and greater brain injury. Neonates with HIE had rectal temperature and near-infrared spectroscopy autoregulation monitoring during hypothermia (n=63) and rewarming (n=58). All underwent brain MRI, and a subset received diffusion tensor imaging MRI before day 10 (n=41). Most neonates reached <34°C at 3–6 h of life. MAPOPT was identified in 54/63 (86%) during hypothermia and in 53/58 (91%) during rewarming. Cooling time was not related to blood pressure deviation from MAPOPT. Later cooling was associated with lower ADC scalar in unilateral posterior centrum semiovale but not in other regions. Temperatures above 34°C were associated with blood pressure above MAPOPT but not with brain injury. In neonates who were predominantly cooled after 3 h, cooling time was not associated with autoregulation or overall brain injury. Blood pressure deviation above MAPOPT was associated with temperature above 34°C. Additional studies are needed in a more heterogeneous population.
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DOI：
10.1097/01.wcb.0000123904.17746.92
发表时间：
2004-08-01
影响因子：
6.3
作者：
Roelfsema, V;Bennet, L;Gunn, TJ
通讯作者：
Gunn, TJ
DOI：
10.1056/nejmoa1112066
发表时间：
2012-05-31
期刊：
The New England journal of medicine
影响因子：
--
作者：
Shankaran S;Pappas A;McDonald SA;Vohr BR;Hintz SR;Yolton K;Gustafson KE;Leach TM;Green C;Bara R;Petrie Huitema CM;Ehrenkranz RA;Tyson JE;Das A;Hammond J;Peralta-Carcelen M;Evans PW;Heyne RJ;Wilson-Costello DE;Vaucher YE;Bauer CR;Dusick AM;Adams-Chapman I;Goldstein RF;Guillet R;Papile LA;Higgins RD;Eunice Kennedy Shriver NICHD Neonatal Research Network
通讯作者：
Eunice Kennedy Shriver NICHD Neonatal Research Network
影响因子：
8
作者：
Olsen, Steven L.;DeJonge, Mitchell;Mathur, Amit
通讯作者：
Mathur, Amit
影响因子：
8.3
作者：
Sabir, Hemmen;Scull-Brown, Emma;Thoresen, Marianne
通讯作者：
Thoresen, Marianne
影响因子：
158.5
作者：
Azzopardi, Denis;Strohm, Brenda;Edwards, A. David
通讯作者：
Edwards, A. David