Abstract
Cerebrovascular pressure autoregulation is the physiologic mechanism that holds cerebral blood flow (CBF) relatively constant across changes in cerebral perfusion pressure (CPP). Cerebral vasoreactivity refers to the vasoconstriction and vasodilation that occur during fluctuations in arterial blood pressure (ABP) to maintain autoregulation. These are vital protective mechanisms of the brain. Impairments in pressure autoregulation increase the risk of brain injury and persistent neurologic disability. Autoregulation may be impaired during various neonatal disease states including prematurity, hypoxic–ischemic encephalopathy (HIE), intraventricular hemorrhage, congenital cardiac disease, and infants requiring extracorporeal membrane oxygenation (ECMO). Because infants are exquisitely sensitive to changes in cerebral blood flow (CBF), both hypoperfusion and hyperperfusion can cause significant neurologic injury. We will review neonatal pressure autoregulation and autoregulation monitoring techniques with a focus on brain protection. Current clinical therapies have failed to fully prevent permanent brain injuries in neonates. Adjuvant treatments that support and optimize autoregulation may improve neurologic outcomes.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 602-610 |
| Number of pages | 9 |
| Journal | Pediatric research |
| Volume | 84 |
| Issue number | 5 |
| DOIs | |
| State | Published - Nov 1 2018 |
Funding
The authors disclosed the following financial support for the research, authorship, and/or publication of this article: NIH grants K23NS091382 (C.J.R.) and K08NS080984 (J.K.L.); SPARKS Charity (T.A.); Cambridge Trust and Coordencação de Aperfeiçoa-mento de Pessoal de Nível Superior (C.A.P.E.S.) scholarship (C.S.D.); and Evelyn Trust (T.A.). Competing interests: Dr. Brady is listed as a co-inventor of autoregulation monitoring technology that has been licensed to Medtronic Inc. Dr. Czosnyka has a financial interest in a part of the licensing fee for ICM+ software that is licensed by the University of Cambridge, Cambridge Enterprise Ltd. Dr. Lee is a paid advisory board member for Medtronic Inc. Dr. Lee also received a research grant from Medtronic for a separate clinical study on cerebrovascular autoregulation. This arrangement has been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies. Medtronic did not provide any support (financial or other) or have any input on the current project and manuscript. The remaining authors declare no competing interests.
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health