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

• Published in: Journal of perinatology 2017-08, Vol.37 (8), p.938-942
• Main Authors: Lee, J K, Perin, J, Parkinson, C, O'Connor, M, Gilmore, M M, Reyes, M, Armstrong, J, Jennings, J M, Northington, F J, Chavez-Valdez, R
• Format: Article
• Language: English
• Subjects: 631/378; Alanine; Alanine transaminase; Analysis; Arterial Pressure; Aspartate aminotransferase; Blood pressure; Brain Diseases - physiopathology; Brain Diseases - therapy; Cerebrovascular Circulation - physiology; Creatinine; Creatinine - analysis; Female; Girls; Hepatic encephalopathy; Homeostasis - physiology; Humans; Hypothermia; Hypothermia, Induced - methods; Infant, Newborn; Infant, Newborn, Diseases - physiopathology; Infant, Newborn, Diseases - therapy; Injuries; Kidney; Kidneys; Liver; Liver Diseases - diagnosis; Liver Diseases - etiology; Liver Function Tests - methods; Male; Medicine; Medicine & Public Health; Neonatal diseases; Neonates; Newborn babies; original-article; Pediatric Surgery; Pediatrics; Regression analysis; Regression models; Renal Insufficiency - diagnosis; Renal Insufficiency - etiology; Statistics as Topic; Transaminases
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/jp.2017.64

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 (MAP OPT ). Autoregulation parameters and creatinine, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were analyzed using adjusted regression models. Results: Greater time with blood pressure within MAP OPT during hypothermia was associated with lower creatinine in girls. Blood pressure below MAP OPT 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 MAP OPT related to higher AST. Conclusions: Blood pressures that optimize cerebral autoregulation may support the kidneys. Blood pressures below MAP OPT and liver injury during normothermia are associated. The relationship between MAP OPT and AST during rewarming requires further study.