Browsing by Author "Randhawa, Alam"

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    Predicting adverse neurological outcomes in infants receiving therapeutic hypothermia for hypoxic ischemic encephalopathy
    (2023-06) Randhawa, Alam; Esser, Michael; Mohammad, Khorshid; Pittman, Quentin
    Background: Hypoxic Ischemic Encephalopathy (HIE) is a categorization of term infants with brain injury caused by a lack of oxygen and/or blood flow to the brain. Despite, therapeutic hypothermia (TH) treatment, consequences of HIE can include life-long disability or even death. Current diagnostic tools may not always be associated with outcomes. Thus, better tools are needed for prognostication. Near-infrared spectroscopy (NIRS) measures of cerebral regional oxygenation (rSO2) is a growing area of interest for prognostication. Objective: The objective of this study is to determine if changes in rSO2 measured via NIRS during TH are associated with brain injury or neurodevelopmental outcomes in term infants. Study Design: A retrospective cohort study of 36 term (>35 weeks gestation) infants born between March 01, 2018 – March 21, 2020. All infants met the criteria for TH based on hospital protocol. The rSO2 was measured alongside other variables in a clinical profile. Statistical analysis and machine learning (ML) algorithms were used to determine which variables were associated with the short-term outcome of brain injury on MRI or long-term outcomes of neurodevelopmental impairments within 3 years of life. Results: In our cohort, it was difficult to predict brain injury and neurodevelopmental outcomes based on HIE severity at birth as well as MRI. Mean rSO2 was not associated with MRI. Although not statistically significant, higher mean rSO2 values with less variability were associated with neurodevelopmental impairments and consistently higher in infants with moderate/severe HIE. NIRS may be an important predictor when only monitoring tools (MRI and EEG) are considered, and in conjunction with other variables in the clinical profile. Conclusion: These findings suggest that infants who go on to have neurodevelopmental impairments may have dysregulation in oxygen extraction, neurovascular coupling (NVC) or cerebral autoregulation in the cerebral cortical region of the brain. Future work should include increasing the sample size, enhancing data capture and machine learning (ML) algorithms, expanding follow-up to school age children as well as investigating brain functionality, connectivity regional oxygen saturation in various brain regions.