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Published on: December 10, 2014
Cerebral autoregulation in pediatric and neonatal intensive care: A scoping review
Marta Fedriga1, Silvia Martini2, Francesca G Iodice3
1Neonatal and Paediatric Intensive Care Unit, IRCCS Giannina Gaslini Institute, Genoa, Italy.
Insights
Cerebral autoregulation (CA) monitoring in children and neonates is not standardized. This review found varied methods and limited evidence, highlighting the need for further research before widespread clinical adoption for pediatric brain injury.
Area of Science:
- Neuroscience
- Pediatric Critical Care
- Neurology
Background:
- Deranged cerebral autoregulation (CA) is linked to poor outcomes in adult brain injury.
- Current CA monitoring strategies are established for adults but not yet for pediatric populations.
- Understanding CA in children is crucial for improving neurological outcomes.
Purpose of the Study:
- To conduct a scoping review of current evidence on cerebral autoregulation (CA) assessment in pediatric and neonatal populations.
- To identify patient groups, CA monitoring methods, and their relationship with clinical outcomes in children.
- To evaluate the feasibility of implementing CA monitoring in pediatric intensive care.
Main Methods:
- A comprehensive literature search was performed across three bibliographic databases.
- Studies published up to December 31st, 2022, were included.
- 135 studies were selected from 494 initially screened papers.
Main Results:
- Evidence exists for CA measurement in diverse pediatric diagnostic categories and age groups.
- Significant heterogeneity was observed in techniques, indices, and thresholds used for CA assessment.
- The number of studies and methodological variations limit conclusive evidence for universal CA monitoring adoption.
Conclusions:
- Cerebral autoregulation (CA) can be measured in pediatric and neonatal populations.
- Current methods for CA assessment in children are highly variable.
- Further research is required to establish standardized CA monitoring techniques and understand their clinical impact in pediatric intensive care.
Abstract:
Deranged cerebral autoregulation (CA) is associated with worse outcome in adult brain injury. Strategies for monitoring CA and maintaining the brain at its 'best CA status' have been implemented, however, this approach has not yet developed for the paediatric population. This scoping review aims to find up-to-date evidence on CA assessment in children and neonates with a view to identify patient categories in which CA has been measured so far, CA monitoring methods and its relationship with clinical outcome if any. A literature search was conducted for studies published within 31st December 2022 in 3 bibliographic databases. Out of 494 papers screened, this review includes 135 studies. Our literature search reveals evidence for CA measurement in the paediatric population across different diagnostic categories and age groups. The techniques adopted, indices and thresholds used to assess and define CA are heterogeneous. We discuss the relevance of available evidence for CA assessment in the paediatric population. However, due to small number of studies and heterogeneity of methods used, there is no conclusive evidence to support universal adoption of CA monitoring, technique, and methodology. This calls for further work to understand the clinical impact of CA monitoring in paediatric and neonatal intensive care.
