Sex-specific associations between cerebrovascular blood pressure autoregulation and cardiopulmonary injury in neonatal encephalopathy and therapeutic hypothermia

Raul Chavez-Valdez, Matthew O'Connor, Jamie L. Perin, Michael Reyes, Jillian Armstrong, Charlamaine Parkinson, Maureen Gilmore, Jacky Jennings, Frances Northington, Jennifer Lee-Summers

Research output: Contribution to journalArticle

Abstract

Background:Cardiopulmonary injury is common in neonatal encephalopathy, but the link with cerebrovascular dysfunction is unknown. We hypothesized that alterations of cerebral autoregulation are associated with cardiopulmonary injury in neonates treated with therapeutic hypothermia (TH) for neonatal encephalopathy.Methods:The cerebral hemoglobin volume index (HVx) from near-infrared spectroscopy was used to identify the mean arterial blood pressure (MAP) with optimal autoregulatory vasoreactivity (MAP OPT). We measured associations between MAP relative to MAP OPT and indicators of cardiopulmonary injury (duration of mechanical respiratory support and administration of inhaled nitric oxide (iNO), milrinone, or steroids).Results:We identified associations between cerebrovascular autoregulation and cardiopulmonary injury that were often sex-specific. Greater MAP deviation above MAP OPT was associated with shorter duration of intubation in boys but longer ventilatory support in girls. Greater MAP deviation below MAP OPT related to longer intensive care stay in boys. Milrinone was associated with greater MAP deviation below MAP OPT in girls.Conclusion:MAP deviation from MAP OPT may relate to cardiopulmonary injury after neonatal encephalopathy, and sex may modulate this relationship. Whereas MAP above MAP OPT may protect the brain and lungs in boys, it may be related to cardiopulmonary injury in girls. Future studies are needed to characterize the role of sex in these associations.

Original languageEnglish (US)
Pages (from-to)759-766
Number of pages8
JournalPediatric Research
Volume81
Issue number5
DOIs
StatePublished - May 1 2017

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Induced Hypothermia
Brain Diseases
Arterial Pressure
Homeostasis
Blood Pressure
Wounds and Injuries
Milrinone

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

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title = "Sex-specific associations between cerebrovascular blood pressure autoregulation and cardiopulmonary injury in neonatal encephalopathy and therapeutic hypothermia",
abstract = "Background:Cardiopulmonary injury is common in neonatal encephalopathy, but the link with cerebrovascular dysfunction is unknown. We hypothesized that alterations of cerebral autoregulation are associated with cardiopulmonary injury in neonates treated with therapeutic hypothermia (TH) for neonatal encephalopathy.Methods:The cerebral hemoglobin volume index (HVx) from near-infrared spectroscopy was used to identify the mean arterial blood pressure (MAP) with optimal autoregulatory vasoreactivity (MAP OPT). We measured associations between MAP relative to MAP OPT and indicators of cardiopulmonary injury (duration of mechanical respiratory support and administration of inhaled nitric oxide (iNO), milrinone, or steroids).Results:We identified associations between cerebrovascular autoregulation and cardiopulmonary injury that were often sex-specific. Greater MAP deviation above MAP OPT was associated with shorter duration of intubation in boys but longer ventilatory support in girls. Greater MAP deviation below MAP OPT related to longer intensive care stay in boys. Milrinone was associated with greater MAP deviation below MAP OPT in girls.Conclusion:MAP deviation from MAP OPT may relate to cardiopulmonary injury after neonatal encephalopathy, and sex may modulate this relationship. Whereas MAP above MAP OPT may protect the brain and lungs in boys, it may be related to cardiopulmonary injury in girls. Future studies are needed to characterize the role of sex in these associations.",
author = "Raul Chavez-Valdez and Matthew O'Connor and Perin, {Jamie L.} and Michael Reyes and Jillian Armstrong and Charlamaine Parkinson and Maureen Gilmore and Jacky Jennings and Frances Northington and Jennifer Lee-Summers",
year = "2017",
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TY - JOUR

T1 - Sex-specific associations between cerebrovascular blood pressure autoregulation and cardiopulmonary injury in neonatal encephalopathy and therapeutic hypothermia

AU - Chavez-Valdez, Raul

AU - O'Connor, Matthew

AU - Perin, Jamie L.

AU - Reyes, Michael

AU - Armstrong, Jillian

AU - Parkinson, Charlamaine

AU - Gilmore, Maureen

AU - Jennings, Jacky

AU - Northington, Frances

AU - Lee-Summers, Jennifer

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Background:Cardiopulmonary injury is common in neonatal encephalopathy, but the link with cerebrovascular dysfunction is unknown. We hypothesized that alterations of cerebral autoregulation are associated with cardiopulmonary injury in neonates treated with therapeutic hypothermia (TH) for neonatal encephalopathy.Methods:The cerebral hemoglobin volume index (HVx) from near-infrared spectroscopy was used to identify the mean arterial blood pressure (MAP) with optimal autoregulatory vasoreactivity (MAP OPT). We measured associations between MAP relative to MAP OPT and indicators of cardiopulmonary injury (duration of mechanical respiratory support and administration of inhaled nitric oxide (iNO), milrinone, or steroids).Results:We identified associations between cerebrovascular autoregulation and cardiopulmonary injury that were often sex-specific. Greater MAP deviation above MAP OPT was associated with shorter duration of intubation in boys but longer ventilatory support in girls. Greater MAP deviation below MAP OPT related to longer intensive care stay in boys. Milrinone was associated with greater MAP deviation below MAP OPT in girls.Conclusion:MAP deviation from MAP OPT may relate to cardiopulmonary injury after neonatal encephalopathy, and sex may modulate this relationship. Whereas MAP above MAP OPT may protect the brain and lungs in boys, it may be related to cardiopulmonary injury in girls. Future studies are needed to characterize the role of sex in these associations.

AB - Background:Cardiopulmonary injury is common in neonatal encephalopathy, but the link with cerebrovascular dysfunction is unknown. We hypothesized that alterations of cerebral autoregulation are associated with cardiopulmonary injury in neonates treated with therapeutic hypothermia (TH) for neonatal encephalopathy.Methods:The cerebral hemoglobin volume index (HVx) from near-infrared spectroscopy was used to identify the mean arterial blood pressure (MAP) with optimal autoregulatory vasoreactivity (MAP OPT). We measured associations between MAP relative to MAP OPT and indicators of cardiopulmonary injury (duration of mechanical respiratory support and administration of inhaled nitric oxide (iNO), milrinone, or steroids).Results:We identified associations between cerebrovascular autoregulation and cardiopulmonary injury that were often sex-specific. Greater MAP deviation above MAP OPT was associated with shorter duration of intubation in boys but longer ventilatory support in girls. Greater MAP deviation below MAP OPT related to longer intensive care stay in boys. Milrinone was associated with greater MAP deviation below MAP OPT in girls.Conclusion:MAP deviation from MAP OPT may relate to cardiopulmonary injury after neonatal encephalopathy, and sex may modulate this relationship. Whereas MAP above MAP OPT may protect the brain and lungs in boys, it may be related to cardiopulmonary injury in girls. Future studies are needed to characterize the role of sex in these associations.

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