Relationship Between Cerebral Oxygenation and Metabolism During Rewarming in Newborn Infants After Therapeutic Hypothermia Following Hypoxic-Ischemic Brain Injury

Subhabrata Mitra, Gemma Bale, Judith Meek, Cristina Uria-Avellanal, Nicola J Robertson, Ilias Tachtsidis

Research output: Chapter in Book/Report/Conference proceedingConference contribution

Abstract

Therapeutic hypothermia (TH) has become a standard of care following hypoxic ischemic encephalopathy (HIE). After TH, body temperature is brought back to 37 °C over 14 h. Lactate/N-acetylasperatate (Lac/NAA) peak area ratio on proton magnetic resonance spectroscopy ((1)H MRS) is the best available outcome biomarker following HIE. We hypothesized that broadband near infrared spectroscopy (NIRS) measured changes in the oxidation state of cytochrome-c-oxidase concentration (Δ[oxCCO]) and cerebral hemodynamics during rewarming would relate to Lac/NAA. Broadband NIRS and systemic data were collected during rewarming from 14 infants following HIE over a mean period of 12.5 h. (1)H MRS was performed on day 5-9. Heart rate increased by 20/min during rewarming while blood pressure and peripheral oxygen saturation (SpO2) remained stable. The relationship between mitochondrial metabolism and oxygenation (measured as Δ[oxCCO] and Δ[HbD], respectively) was calculated by linear regression analysis. This was reviewed in three groups: Lac/NAA values <0.5, 0.5-1, >1. Mean regression coefficient (r (2)) values in these groups were 0.41 (±0.27), 0.22 (±0.21) and 0.01, respectively. The relationship between mitochondrial metabolism and oxygenation became impaired with rising Lac/NAA. Cardiovascular parameters remained stable during rewarming.

Original languageEnglish
Title of host publicationOxygen Transport to Tissue
PublisherSpringer
Pages245-251
Number of pages7
Volume923
DOIs
Publication statusE-pub ahead of print - 16 Aug 2016

Publication series

NameAdvances in Experimental Medicine and Biology
PublisherSpringer Verlag
ISSN (Print)0065-2598

Keywords

  • Aspartic Acid/analogs & derivatives
  • Biomarkers/blood
  • Body Temperature Regulation
  • Cerebrovascular Circulation
  • Electron Transport Complex IV/metabolism
  • Female
  • Hemoglobins/metabolism
  • Humans
  • Hypothermia, Induced
  • Hypoxia-Ischemia, Brain/blood
  • Infant, Newborn
  • Lactic Acid/metabolism
  • Linear Models
  • Male
  • Mitochondria/metabolism
  • Oxidation-Reduction
  • Oximetry/methods
  • Oxygen/blood
  • Oxygen Consumption
  • Predictive Value of Tests
  • Proton Magnetic Resonance Spectroscopy
  • Rewarming
  • Spectroscopy, Near-Infrared
  • Time Factors
  • Treatment Outcome

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