Evidence map›Paper›PMID 26486728›Full record

ArticleBMC neurology2015

A pilot cohort study of cerebral autoregulation and 2-year neurodevelopmental outcomes in neonates with hypoxic-ischemic encephalopathy who received therapeutic hypothermia.

Vera Joanna Burton, Gwendolyn Gerner, Elizabeth Cristofalo, Shang-en Chung, Jacky M Jennings, Charlamaine Parkinson, Raymond C Koehler, Raul Chavez-Valdez, Michael V Johnston, Frances J Northington and 1 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC neurology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 50 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
50citing papers in PubMed, 1 pooled it
11.5field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

50 citing papers in PubMed, 1 synthesis or guideline pooled it, 76 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
  4. Article
  5. Review
  6. Cerebral autoregulation in pediatric and neonatal intensive care: A scoping review.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2024
    Article
  7. Review
  8. Review
  9. Review
  10. Article
  11. Review
  12. Observational
  13. Review
  14. Observational
  15. Article
  16. Article
  17. Bedside and laboratory neuromonitoring in neonatal encephalopathy.Seminars in fetal & neonatal medicine · 2021
    Review
  18. Article
  19. Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 3 institutions in 1 country.

Vera Joanna BurtonNeurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA. BurtonJ@kennedykrieger.org.
Gwendolyn GernerNeurosciences Intensive Care Nursery, Johns Hopkins School of Medicine, Baltimore, MD, USA. GernerG@kennedykrieger.org.
Elizabeth CristofaloNeurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA. ecristofalo@jhmi.edu.
Shang-en ChungCenter for Child and Community Health Research (CCHR), Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA. schung2@jhmi.edu.
Jacky M JenningsCenter for Child and Community Health Research (CCHR), Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA. jjennin1@jhmi.edu.
Charlamaine ParkinsonNeurosciences Intensive Care Nursery, Johns Hopkins School of Medicine, Baltimore, MD, USA. chenson1@jhmi.edu.
Raymond C KoehlerDepartment of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA. rkoehler@jhmi.edu.
Raul Chavez-ValdezNeurosciences Intensive Care Nursery, Johns Hopkins School of Medicine, Baltimore, MD, USA. rchavez2@jhmi.edu.
Michael V JohnstonNeurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA. Johnston@kennedykrieger.org.
Frances J NorthingtonNeurosciences Intensive Care Nursery, Johns Hopkins School of Medicine, Baltimore, MD, USA. frances@jhmi.edu.
Jennifer K LeeNeurosciences Intensive Care Nursery, Johns Hopkins School of Medicine, Baltimore, MD, USA. jklee@jhmi.edu.
Johns Hopkins University · USJohns Hopkins Medicine · USKennedy Krieger Institute · US

Funding

Therapeutic Strategies for Neonatal Hypoxic-Ischemiic EncephalopathyR01NS060703 · NINDS · JOHNS HOPKINS UNIVERSITY · PI KOEHLER, RAYMOND CHARLES · 2008 to 2019
$3.9M
NEUROLOGY SCIENCES ACADEMIC DEVELOPMENT AWARD (NSADA)K12NS001696 · NINDS · JOHNS HOPKINS UNIVERSITY · PI JOHNSTON, MICHAEL VAN DOREN · 1993 to 2016
$3.8M
Mechanisms of Hypothermic Neuroprotection in NeonatesR01HD070996 · NICHD · JOHNS HOPKINS UNIVERSITY · PI NORTHINGTON, FRANCES J · 2012 to 2016
$1.7M
Neuronal injury after pediatric cardiac arrest, hypothermia, and rewarmingK08NS080984 · NINDS · JOHNS HOPKINS UNIVERSITY · PI LEE, JENNIFER KIM · 2014 to 2018
$960k
NICHD NIH HHS HD070996NICHD NIH HHS R01 HD070996NINDS NIH HHS K08 NS080984NINDS NIH HHS K12 NS001696NINDS NIH HHS K12-NS001696NINDS NIH HHS R01 NS060703
6 · The paper itself

Abstract

backgroundNeurodevelopmental disabilities persist in survivors of neonatal hypoxic-ischemic encephalopathy (HIE) despite treatment with therapeutic hypothermia. Cerebrovascular autoregulation, the mechanism that maintains cerebral perfusion during changes in blood pressure, may influence outcomes. Our objective was to describe the relationship between acute autoregulatory vasoreactivity during treatment and neurodevelopmental outcomes at 2 years of age.

methodsIn a pilot study of 28 neonates with HIE, we measured cerebral autoregulatory vasoreactivity with the hemoglobin volume index (HVx) during therapeutic hypothermia, rewarming, and the first 6 h of normothermia. The HVx, which is derived from near-infrared spectroscopy, was used to identify the individual optimal mean arterial blood pressure (MAPOPT) at which autoregulatory vasoreactivity is greatest. Cognitive and motor neurodevelopmental evaluations were completed in 19 children at 21-32 months of age. MAPOPT, blood pressure in relation to MAPOPT, blood pressure below gestational age + 5 (ga + 5), and regional cerebral oximetry (rSO2) were compared to the neurodevelopmental outcomes.

resultsNineteen children who had HIE and were treated with therapeutic hypothermia performed in the average range on cognitive and motor evaluations at 21-32 months of age, although the mean performance was lower than that of published normative samples. Children with impairments at the 2-year evaluation had higher MAPOPT values, spent more time with blood pressure below MAPOPT, and had greater blood pressure deviation below MAPOPT during rewarming in the neonatal period than those without impairments. Greater blood pressure deviation above MAPOPT during rewarming was associated with less disability and higher cognitive scores. No association was observed between rSO2 or blood pressure below ga + 5 and neurodevelopmental outcomes.

conclusionIn this pilot cohort, motor and cognitive impairments at 21-32 months of age were associated with greater blood pressure deviation below MAPOPT during rewarming following therapeutic hypothermia, but not with rSO2 or blood pressure below ga + 5. This suggests that identifying individual neonates' MAPOPT is superior to using hemodynamic goals based on gestational age or rSO2 in the acute management of neonatal HIE.

Indexed as

Arterial PressureBlood PressureCerebrovascular CirculationChild DevelopmentChild, PreschoolCognitionCohort StudiesFemaleHemodynamicsHemoglobinsHomeostasisHumansHypothermia, InducedHypoxia-Ischemia, BrainInfantInfant, NewbornHemoglobins

Identifiers

PMID26486728
PMCPMC4618147
OpenAlexW2103712981

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.