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Haemodynamic Instability and Brain Injury in Neonates Exposed to Hypoxia–Ischaemia

1
The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne 3168, Australia
2
Newborn Research Centre, The Royal Women’s Hospital, Melbourne 3052, Australia
*
Author to whom correspondence should be addressed.
Brain Sci. 2019, 9(3), 49; https://doi.org/10.3390/brainsci9030049
Received: 1 February 2019 / Revised: 24 February 2019 / Accepted: 26 February 2019 / Published: 27 February 2019
(This article belongs to the Special Issue The Treatment of Neonatal Hypoxic-Ischemic Encephalopathy)
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Abstract

Brain injury in the asphyxic newborn infant may be exacerbated by delayed restoration of cardiac output and oxygen delivery. With increasing severity of asphyxia, cerebral autoregulatory responses are compromised. Further brain injury may occur in association with high arterial pressures and cerebral blood flows following the restoration of cardiac output. Initial resuscitation aims to rapidly restore cardiac output and oxygenation whilst mitigating the impact of impaired cerebral autoregulation. Recent animal studies have indicated that the current standard practice of immediate umbilical cord clamping prior to resuscitation may exacerbate injury. Resuscitation prior to umbilical cord clamping confers several haemodynamic advantages. In particular, it retains the low-resistance placental circuit that mitigates the rebound hypertension and cerebrovascular injury. Prolonged cerebral hypoxia–ischaemia is likely to contribute to further perinatal brain injury, while, at the same time, tissue hyperoxia is associated with oxidative stress. Efforts to monitor and target cerebral flow and oxygen kinetics, for example, using near-infrared spectroscopy, are currently being evaluated and may facilitate development of novel resuscitation approaches. View Full-Text
Keywords: hypoxic–ischaemic encephalopathy; asphyxia; neonate; cord clamping; oxygen; haemodynamic hypoxic–ischaemic encephalopathy; asphyxia; neonate; cord clamping; oxygen; haemodynamic
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Badurdeen, S.; Roberts, C.; Blank, D.; Miller, S.; Stojanovska, V.; Davis, P.; Hooper, S.; Polglase, G. Haemodynamic Instability and Brain Injury in Neonates Exposed to Hypoxia–Ischaemia. Brain Sci. 2019, 9, 49.

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