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Exploratory Assessment of the Relationship Between Hemoglobin Volume Phase Index, Magnetic Resonance Imaging, and Functional Outcome in Neonates with Hypoxic–Ischemic Encephalopathy

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Abstract

Background/Objective

Near-infrared spectroscopy (NIRS)-based measures of cerebral autoregulation (CAR) can potentially identify neonates with hypoxic–ischemic encephalopathy (HIE) who are at greatest risk of irreversible brain injury. However, modest predictive abilities have precluded previously described metrics from entering clinical care. We previously validated a novel autoregulation metric in a piglet model of induced hypotension called the hemoglobin volume phase index (HVP). The objective of this study was to evaluate the clinical ability of the HVP to predict adverse outcomes neonates with HIE.

Methods

This is a prospective study of neonates with HIE who underwent therapeutic hypothermia (TH) at a level 4 neonatal intensive care unit (NICU). Continuous cerebral NIRS and mean arterial blood pressure (MAP) from indwelling arterial catheters were measured during TH and through rewarming. Multivariate autoregressive process was used to calculate the coherence between MAP and the sum total of the oxy- and deoxygenated Hb densities (HbT), a surrogate measure of cerebral blood volume (CBV). The HVP was calculated as the cosine-transformed phase shift at the frequency of maximal MAP-HbT coherence. Brain injury was assessed by neonatal magnetic resonance imaging (MRI), and developmental outcomes were assessed by the Bayley Scales of Infant Development (BSID-III) at 15–30 months. The ability of the HVP to predict (a) death or severe brain injury by MRI and (b) death or significant developmental delay was assessed using logistic regression analyses.

Results

In total, 50 neonates with moderate or severe HIE were monitored. Median HVP was higher, representing more dysfunctional autoregulation, in infants who had adverse outcomes. After adjusting for sex and encephalopathy grade at presentation, HVP at 21–24 and 24–27 h of life predicted death or brain injury by MRI (21–24 h: OR 8.8, p = 0.037; 24–27 h: OR 31, p = 0.011) and death or developmental delay at 15–30 months (21–24 h: OR 11.8, p = 0.05; 24–27 h: OR 15, p = 0.035).

Conclusions

Based on this pilot study of neonates with HIE, HVP merits further study as an indicator of death or severe brain injury on neonatal MRI and neurodevelopmental delay in early childhood. Larger studies are warranted for further clinical validation of the HVP to evaluate cerebral autoregulation following HIE.

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Funding

This study was supported by the Clinical and Translational Science Institute at Children’s National (UL1TR000075, 1KL2RR031987-01) and the National Institutes of Health Intellectual and Developmental Disabilities Research Consortium (U54 HD090257).

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Authors and Affiliations

  1. Division of Neonatology, Children’s National Hospital, Washington, DC, USA

    An N. Massaro

  2. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Jennifer K. Lee

  3. Diagnostic Imaging and Radiology, Children’s National Hospital, Washington, DC, USA

    Gilbert Vezina

  4. Psychology and Behavioral Health, Children’s National Hospital, Washington, DC, USA

    Penny Glass

  5. Neurology, Children’s National Hospital, Washington, DC, USA

    Alexandra O’Kane, Ruoying Li & Taeun Chang

  6. Department of Anesthesia, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Kenneth Brady

  7. Fetal and Transitional Medicine, Children’s National Hospital, Washington, DC, USA

    Rathinaswamy Govindan

  8. The George Washington University School of Medicine, Washington, DC, USA

    An N. Massaro, Gilbert Vezina, Penny Glass, Taeun Chang & Rathinaswamy Govindan

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  1. An N. Massaro
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All authors made substantial contributions to 1) conception and design, acquisition of data, or analysis and interpretation of data; 2) drafting the article or revising it critically for important intellectual content; and 3) final approval of the version to be published.

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Correspondence to An N. Massaro.

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JKL is a paid consultant for Edwards Life Sciences. The other authors have no conflicts of interest to declare.

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The study was approved by the Children’s National Institutional Review Board, informed consent was obtained from a parent of each participant and the study was performed in accordance with the ethical standards consistent with the 1964 Declaration of Helsinki.

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Massaro, A.N., Lee, J.K., Vezina, G. et al. Exploratory Assessment of the Relationship Between Hemoglobin Volume Phase Index, Magnetic Resonance Imaging, and Functional Outcome in Neonates with Hypoxic–Ischemic Encephalopathy. Neurocrit Care 35, 121–129 (2021). https://doi.org/10.1007/s12028-020-01150-8

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