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Relationships between cerebral autoregulation and markers of kidney and liver injury in neonatal encephalopathy and therapeutic hypothermia

Journal of Perinatology volume 37, pages 938–942 (2017)Cite this article

Subjects

Abstract

Objective:

We studied whether cerebral blood pressure autoregulation and kidney and liver injuries are associated in neonatal encephalopathy (NE).

Study design:

We monitored autoregulation of 75 newborns who received hypothermia for NE in the neonatal intensive care unit to identify the mean arterial blood pressure with optimized autoregulation (MAPOPT). Autoregulation parameters and creatinine, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were analyzed using adjusted regression models.

Results:

Greater time with blood pressure within MAPOPT during hypothermia was associated with lower creatinine in girls. Blood pressure below MAPOPT related to higher ALT and AST during normothermia in all neonates and boys. The opposite occurred in rewarming when more time with blood pressure above MAPOPT related to higher AST.

Conclusions:

Blood pressures that optimize cerebral autoregulation may support the kidneys. Blood pressures below MAPOPT and liver injury during normothermia are associated. The relationship between MAPOPT and AST during rewarming requires further study.

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Acknowledgements

Support was provided by the NIH R01HD070996 (FJN), R01HD074593 (FJN), K08NS080984 (JKL) and R21HD072845 (JKL); Johns Hopkins University Clinician Scientist Award (JKL); American Heart Association Grant-in-Aid (JKL); and the Sutland-Pakula Endowment for Neonatal Research (RC-V). Funding for the study described in this manuscript was provided in part by Medtronic. JKL was the principal investigator of this grant. The funding was used to support research effort by RC-V, FJN, JP, CP and MR.

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA

    J K Lee, M Reyes & J Armstrong

  2. Neurosciences Intensive Care Nursery, Johns Hopkins School of Medicine, Baltimore, MD, USA

    J K Lee, C Parkinson, M M Gilmore, F J Northington & R Chavez-Valdez

  3. Department of Pediatrics, Center for Child and Community Health Research (CCHR), Johns Hopkins School of Medicine, Baltimore, MD, USA

    J Perin & J M Jennings

  4. Division of Neonatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA

    C Parkinson, M O'Connor, M M Gilmore, F J Northington & R Chavez-Valdez

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  1. J K Lee
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  2. J Perin
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  3. C Parkinson
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  4. M O'Connor
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  5. M M Gilmore
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  6. M Reyes
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  7. J Armstrong
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  8. J M Jennings
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  9. F J Northington
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  10. R Chavez-Valdez
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Corresponding author

Correspondence to J K Lee.

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Competing interests

JKL was a paid advisory board member for Medtronic. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies. In addition, JKL and FJN have been funded by the NIH. The remaining authors declare no conflict of interest.

Additional information

We dedicate this manuscript to the Poretti family in loving memory of Dr Andrea Poretti.

Supplementary Information accompanies the paper on the Journal of Perinatology website

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Lee, J., Perin, J., Parkinson, C. et al. Relationships between cerebral autoregulation and markers of kidney and liver injury in neonatal encephalopathy and therapeutic hypothermia. J Perinatol 37, 938–942 (2017). https://doi.org/10.1038/jp.2017.64

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