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Published on: November 24, 2017
Cerebral Blood Flow of the Neonatal Brain after Hypoxic-Ischemic Injury
Luis Octavio Tierradentro-García1, Sandra Saade-Lemus1,2, Colbey Freeman1,3
1Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Insights
Cerebral blood flow (CBF) assessment in infants with hypoxic-ischemic encephalopathy (HIE) helps identify perfusion abnormalities to guide treatment and predict outcomes. Understanding CBF is crucial for managing neonatal HIE and improving long-term neurodevelopmental effects.
Area of Science:
- Neonatal neurology
- Neurocritical care
- Medical imaging
Background:
- Hypoxic-ischemic encephalopathy (HIE) in newborns can lead to severe, lifelong neurodevelopmental challenges.
- Both reduced blood flow (hypoperfusion) and subsequent reperfusion injury contribute to brain damage in HIE.
- Accurate assessment of cerebral blood flow (CBF) is vital for effective management and prognosis in infants with HIE.
Purpose of the Study:
- To review the pathophysiology of CBF disturbances in neonatal HIE.
- To outline current and novel techniques for quantifying CBF in this population.
- To explore the potential of using CBF as a therapeutic target in acute HIE management.
Main Methods:
- Review of neuroimaging techniques for CBF assessment in neonatal HIE.
- Inclusion of methods such as transcranial Doppler, ASL MRI, NIRS, and PET.
- Discussion of factors influencing CBF measurements and their clinical interpretation.
Main Results:
- Various neuroimaging modalities exist for assessing CBF in HIE, including TCD, ASL MRI, NIRS, and PET.
- There is a lack of consensus on the clinical significance of CBF estimates across different techniques.
- Heterogeneity in imaging methods, scan timing, and patient factors complicates the translation of findings into clinical practice.
Conclusions:
- CBF is a critical biomarker for evaluating brain perfusion in neonatal HIE.
- Standardization is needed for CBF assessment methods to ensure reliable clinical application.
- Further research is required to integrate CBF monitoring effectively into HIE management protocols.
Objective:
Hypoxic-ischemic encephalopathy (HIE) in infants can have long-term adverse neurodevelopmental effects and markedly reduce quality of life. Both the initial hypoperfusion and the subsequent rapid reperfusion can cause deleterious effects in brain tissue. Cerebral blood flow (CBF) assessment in newborns with HIE can help detect abnormalities in brain perfusion to guide therapy and prognosticate patient outcomes.
Study Design:
The review will provide an overview of the pathophysiological implications of CBF derangements in neonatal HIE, current and emerging techniques for CBF quantification, and the potential to utilize CBF as a physiologic target in managing neonates with acute HIE.
Conclusion:
The alterations of CBF in infants during hypoxia-ischemia have been studied by using different neuroimaging techniques, including nitrous oxide and xenon clearance, transcranial Doppler ultrasonography, contrast-enhanced ultrasound, arterial spin labeling MRI, 18F-FDG positron emission tomography, near-infrared spectroscopy (NIRS), functional NIRS, and diffuse correlation spectroscopy. Consensus is lacking regarding the clinical significance of CBF estimations detected by these different modalities. Heterogeneity in the imaging modality used, regional versus global estimations of CBF, time for the scan, and variables impacting brain perfusion and cohort clinical characteristics should be considered when translating the findings described in the literature to routine practice and implementation of therapeutic interventions.
Key Points:
· Hypoxic-ischemic injury in infants can result in adverse long-term neurologic sequelae.. · Cerebral blood flow is a useful biomarker in neonatal hypoxic-ischemic injury.. · Imaging modality, variables affecting cerebral blood flow, and patient characteristics affect cerebral blood flow assessment..
