Cerebral Blood Flow of the Neonatal Brain after Hypoxic–Ischemic Injury

Luis Octavio Tierradentro-García; Sandra Saade-Lemus; Colbey Freeman; Matthew Kirschen; Hao Huang; Arastoo Vossough; Misun Hwang

doi:10.1055/s-0041-1731278

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2023; 40(05): 475-488
DOI: 10.1055/s-0041-1731278

Review Article

Cerebral Blood Flow of the Neonatal Brain after Hypoxic–Ischemic Injury

Luis Octavio Tierradentro-García ‡^*

¹Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

,

Sandra Saade-Lemus‡^*

¹Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

²Department of Neurology, Brigham and Women's Hospital & Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

,

Colbey Freeman

¹Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

³Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania

,

Matthew Kirschen

⁴Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

,

Hao Huang

¹Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

³Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania

,

Arastoo Vossough

¹Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

³Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania

,

Misun Hwang

¹Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

³Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania

› Institutsangaben

Abstract

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.

Keywords

cerebral blood flow - hypoxic–ischemic injury - hypoxic–ischemic encephalopathy - pediatric neurology - neonatal brain

Volltext

Referenzen

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