INFLUENCE OF SYSTEM HEMODYNAMICS ON CEREBRAL PERFUSION IN TERM NEONATES DURING THE ACUTE PERIOD OF HYPOXIC ISCHEMIC ENCEPHALOPATHY

Abstract

Introduction. Hypoxic ischemic encephalopathy is a severe condition of the neonatal period leading to a significant neurological disability. Until now the influence of systemic hemodynamics viz. mean arterial pressure on the indices of cerebral perfusion in term infants remains unclear. Objective. To determine the effect of mean blood pressure on cerebral perfusion and the course of acute period of hypoxic-ischemic encephalopathy in term newborns. Materials and methods. Data of 205 term infants with Apgar score at birth of 7 or less and Sarnat stage II–III was collected during 72 hours of life. The correlation between mean blood pressure, RI and PI indices and Glasgow coma scale, seizures, confirmed by the aEEG, was analyzed as well as development of neurological complications such as cerebral leukomalacia. Results and discussion. In the acute period of HIE Resistive Index (RI) and Pulsatile Index (PI), measured in the anterior cerebral artery on day 3 after the end of the therapeutic hypothermia and brain reperfusion, reliably correlate with frequency of seizures occurred as well as risk of cerebral leukomalacia (p=-0.13; p=0.016). No correlations between mean blood pressure and cerebral perfusion were found in neonates during the acute period of hypoxic ischemic encephalopathy. Conclusion. The evaluation of Doppler indices of cerebral blood flow RI and PI in the acute period of hypoxic ischemic encephalopathy in the term newborns has a significant diagnostic and predictable value and correlates with the severity and short-term clinical follow-up of HIE. Independency of brain perfusion from mean blood pressure evidences about the preservation of autoregulation of cerebral blood flow in term babies with hypoxic ischemic encephalopathy.