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Am J Perinatol 2023; 40(05): 475-488
DOI: 10.1055/s-0041-1731278
Review Article

Cerebral Blood Flow of the Neonatal Brain after Hypoxic–Ischemic Injury

Luis Octavio Tierradentro-García  ‡   *
1   Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
,
Sandra Saade-Lemus‡   *
1   Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
2   Department of Neurology, Brigham and Women's Hospital & Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Colbey Freeman
1   Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
3   Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
,
Matthew Kirschen
4   Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
,
Hao Huang
1   Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
3   Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
,
Arastoo Vossough
1   Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
3   Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
,
Misun Hwang 
1   Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
3   Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
› Author Affiliations Funding None.
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Abstract

Objective Hypoxic–ischemic encephalopathy (HIE) in infants can have long-term adverse neurodevelopmental effects and markedly reduce quality of life. Both the initial hypoperfusion and the subsequent rapid reperfusion can cause deleterious effects in brain tissue. Cerebral blood flow (CBF) assessment in newborns with HIE can help detect abnormalities in brain perfusion to guide therapy and prognosticate patient outcomes.

Study Design The review will provide an overview of the pathophysiological implications of CBF derangements in neonatal HIE, current and emerging techniques for CBF quantification, and the potential to utilize CBF as a physiologic target in managing neonates with acute HIE.

Conclusion The alterations of CBF in infants during hypoxia-ischemia have been studied by using different neuroimaging techniques, including nitrous oxide and xenon clearance, transcranial Doppler ultrasonography, contrast-enhanced ultrasound, arterial spin labeling MRI, 18F-FDG positron emission tomography, near-infrared spectroscopy (NIRS), functional NIRS, and diffuse correlation spectroscopy. Consensus is lacking regarding the clinical significance of CBF estimations detected by these different modalities. Heterogeneity in the imaging modality used, regional versus global estimations of CBF, time for the scan, and variables impacting brain perfusion and cohort clinical characteristics should be considered when translating the findings described in the literature to routine practice and implementation of therapeutic interventions.

Key Points

  • Hypoxic–ischemic injury in infants can result in adverse long-term neurologic sequelae.

  • Cerebral blood flow is a useful biomarker in neonatal hypoxic–ischemic injury.

  • Imaging modality, variables affecting cerebral blood flow, and patient characteristics affect cerebral blood flow assessment.

Keywords

cerebral blood flow - hypoxic–ischemic injury - hypoxic–ischemic encephalopathy - pediatric neurology - neonatal brain

* These authors contributed equally to this study.




Publication History

Received: 28 November 2020

Accepted: 12 May 2021

Article published online:
05 July 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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