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Lacan L, Garabedian C, De Jonckheere J, Ghesquiere L, Storme L, Sharma D, Nguyen The Tich S. Fetal brain response to worsening acidosis: an experimental study in a fetal sheep model of umbilical cord occlusions. Sci Rep 2023; 13:23050. [PMID: 38155199 PMCID: PMC10754920 DOI: 10.1038/s41598-023-49495-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 12/08/2023] [Indexed: 12/30/2023] Open
Abstract
Perinatal anoxia remains an important public health problem as it can lead to hypoxic-ischaemic encephalopathy (HIE) and cause significant neonatal mortality and morbidity. The mechanisms of the fetal brain's response to hypoxia are still unclear and current methods of in utero HIE prediction are not reliable. In this study, we directly analysed the brain response to hypoxia in fetal sheep using in utero EEG. Near-term fetal sheep were subjected to progressive hypoxia induced by repeated umbilical cord occlusions (UCO) at increasing frequency. EEG changes during and between UCO were analysed visually and quantitatively, and related with gasometric and haemodynamic data. EEG signal was suppressed during occlusions and progressively slowed between occlusions with the increasing severity of the occlusions. Per-occlusion EEG suppression correlated with per-occlusion bradycardia and increased blood pressure, whereas EEG slowing and amplitude decreases correlated with arterial hypotension and respiratory acidosis. The suppression of the EEG signal during cord occlusion, in parallel with cardiovascular adaptation could correspond to a rapid cerebral adaptation mechanism that may have a neuroprotective role. The progressive alteration of the signal with the severity of the occlusions would rather reflect the cerebral hypoperfusion due to the failure of the cardiovascular adaptation mechanisms.
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Affiliation(s)
- Laure Lacan
- CHU Lille, Univ. Lille, ULR 2694 - METRICS, 59000, Lille, France.
- Department of Pediatric Neurology, CHU Lille, 59000, Lille, France.
- Department of Pediatric Neurology, Hôpital Roger Salengro, CHU Lille, Avenue du Professeur Emile Laine, 59037, Lille Cedex, France.
| | - Charles Garabedian
- CHU Lille, Univ. Lille, ULR 2694 - METRICS, 59000, Lille, France
- Department of Obstetrics, CHU Lille, 59000, Lille, France
| | - Julien De Jonckheere
- CHU Lille, Univ. Lille, ULR 2694 - METRICS, 59000, Lille, France
- CHU Lille, CIC-IT 1403, 59000, Lille, France
| | - Louise Ghesquiere
- CHU Lille, Univ. Lille, ULR 2694 - METRICS, 59000, Lille, France
- Department of Obstetrics, CHU Lille, 59000, Lille, France
| | - Laurent Storme
- CHU Lille, Univ. Lille, ULR 2694 - METRICS, 59000, Lille, France
- Department of Neonatology, CHU Lille, 59000, Lille, France
| | - Dyuti Sharma
- CHU Lille, Univ. Lille, ULR 2694 - METRICS, 59000, Lille, France
- Department of Pediatric Surgery, CHU Lille, 59000, Lille, France
| | - Sylvie Nguyen The Tich
- CHU Lille, Univ. Lille, ULR 2694 - METRICS, 59000, Lille, France
- Department of Pediatric Neurology, CHU Lille, 59000, Lille, France
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Ghesquière L, Perbet R, Lacan L, Hamoud Y, Stichelbout M, Sharma D, Nguyen S, Storme L, Houfflin-Debarge V, De Jonckheere J, Garabedian C. Associations between fetal heart rate variability and umbilical cord occlusions-induced neural injury: An experimental study in a fetal sheep model. Acta Obstet Gynecol Scand 2022; 101:758-770. [PMID: 35502642 DOI: 10.1111/aogs.14352] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/27/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This study evaluated the association between fetal heart rate variability (HRV) and the occurrence of hypoxic-ischemic encephalopathy in a fetal sheep model. MATERIAL AND METHODS The experimental protocol created a hypoxic condition with repeated cord occlusions in three phases (A, B, C) to achieve acidosis to pH <7.00. Hemodynamic, gasometric and HRV parameters were analyzed during the protocol, and the fetal brain, brainstem and spinal cord were assessed histopathologically 48 h later. Associations between the various parameters and neural injury were compared between phases A, B and C using Spearman's rho test. RESULTS Acute anoxic-ischemic brain lesions in all regions was present in 7/9 fetuses, and specific neural injury was observed in 3/9 fetuses. The number of brainstem lesions correlated significantly and inversely with the HRV fetal stress index (r = -0.784; p = 0.021) in phase C and with HRV long-term variability (r = -0.677; p = 0.045) and short-term variability (r = -0.837; p = 0.005) in phase B. The number of neurological lesions did not correlate significantly with other markers of HRV. CONCLUSIONS Neural injury caused by severe hypoxia was associated with HRV changes; in particular, brainstem damage was associated with changes in fetal-specific HRV markers.
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Affiliation(s)
- Louise Ghesquière
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Obstetrics, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Romain Perbet
- Department of Anatomopathology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Laure Lacan
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Neuropediatrics, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Yasmine Hamoud
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Obstetrics, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Morgane Stichelbout
- Department of Anatomopathology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Dyuti Sharma
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Pediatric Surgery, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Sylvie Nguyen
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Neuropediatrics, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Laurent Storme
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Neonatology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Véronique Houfflin-Debarge
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Obstetrics, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Julien De Jonckheere
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Clinical Investigation Center - Technological Innovation (CIC-IT 1403), Centre Hospitalier Universitaire de Lille, Lille, France
| | - Charles Garabedian
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Obstetrics, Centre Hospitalier Universitaire de Lille, Lille, France
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Ghesquière L, Ternynck C, Sharma D, Hamoud Y, Vanspranghels R, Storme L, Houfflin-Debarge V, De Jonckheere J, Garabedian C. Heart rate markers for prediction of fetal acidosis in an experimental study on fetal sheep. Sci Rep 2022; 12:10615. [PMID: 35739219 PMCID: PMC9226053 DOI: 10.1038/s41598-022-14727-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 06/10/2022] [Indexed: 11/09/2022] Open
Abstract
To overcome the difficulties in interpreting fetal heart rate (FHR), several tools based on the autonomic nervous system and heart rate variability (HRV) have been developed. The objective of this study was to use FHR and HRV parameters for the prediction of fetal hypoxia. It was an experimental study in the instrumented fetal sheep. Repeated umbilical cord occlusions were performed to achieve severe acidosis. Hemodynamic parameters, ECG, and blood gases were analyzed. The variables used were heart rate baseline, HRV analysis (RMSSD, SDNN, LF, HF, HFnu, Fetal Stress Index (FSI), …), and morphological analysis of decelerations. The gold standard used to classify hypoxia was the fetal arterial pH (pH < 7.10). Different multivariable statistical methods (logistic regression and decision trees) were applied for the detection of acidosis. 21 lambs were instrumented. A total of 130 pairs of FHR/fetal pH analysis were obtained of which 29 in the acidosis group and 101 in the non-acidosis group. After logistic regression model with bootstrap resampling and stepwise backward selection, only one variable was selected, FSI. The AUC of FSI alone in this model was 0.81 with a sensitivity of 0.66, specificity of 0.88, PPV of 0.61, and NPV of 0.90 considering a threshold of 68. Decision trees with CHAID and CART algorithms showed a sensitivity of 0.48 and 0.59, respectively, and a specificity of 0.94 for both. All employed methods identified HRV variables as the most predictive of acidosis. The primary variables selected automatically were those from the HRV. Supporting the use of FHRV measures for the screening of fetal acidosis during labour is interesting.
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Affiliation(s)
- Louise Ghesquière
- Univ. Lille, CHU Lille, ULR 2694-METRICS-Evaluation des technologies de santé et des pratiques médicales, 59000, Lille, France.
- Department of Obstetrics, CHU Lille, 59000, Lille, France.
- Department of Obstetrics, CHU Lille, Avenue Eugène Avinée, 59037, Lille Cedex, France.
| | - C Ternynck
- Univ. Lille, CHU Lille, ULR 2694-METRICS-Evaluation des technologies de santé et des pratiques médicales, 59000, Lille, France
- Department of Biostatistics, CHU Lille, 59000, Lille, France
| | - D Sharma
- Univ. Lille, CHU Lille, ULR 2694-METRICS-Evaluation des technologies de santé et des pratiques médicales, 59000, Lille, France
- Department of Pediatric Surgery, CHU Lille, 59000, Lille, France
| | - Y Hamoud
- Univ. Lille, CHU Lille, ULR 2694-METRICS-Evaluation des technologies de santé et des pratiques médicales, 59000, Lille, France
- Department of Obstetrics, CHU Lille, 59000, Lille, France
| | - R Vanspranghels
- Univ. Lille, CHU Lille, ULR 2694-METRICS-Evaluation des technologies de santé et des pratiques médicales, 59000, Lille, France
- Department of Obstetrics, CHU Lille, 59000, Lille, France
| | - L Storme
- Univ. Lille, CHU Lille, ULR 2694-METRICS-Evaluation des technologies de santé et des pratiques médicales, 59000, Lille, France
- Department of Neonatology, CHU Lille, 59000, Lille, France
| | - V Houfflin-Debarge
- Univ. Lille, CHU Lille, ULR 2694-METRICS-Evaluation des technologies de santé et des pratiques médicales, 59000, Lille, France
- Department of Obstetrics, CHU Lille, 59000, Lille, France
| | - J De Jonckheere
- Univ. Lille, CHU Lille, ULR 2694-METRICS-Evaluation des technologies de santé et des pratiques médicales, 59000, Lille, France
- CHU Lille, CIC-IT 1403, 59000, Lille, France
| | - C Garabedian
- Univ. Lille, CHU Lille, ULR 2694-METRICS-Evaluation des technologies de santé et des pratiques médicales, 59000, Lille, France
- Department of Obstetrics, CHU Lille, 59000, Lille, France
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Lear CA, Westgate JA, Kasai M, Beacom MJ, Maeda Y, Magawa S, Miyagi E, Ikeda T, Bennet L, Gunn AJ. Reply to the "Letter to the Editor: measurement of fetal parasympathetic activity during labor: a new pathway for evaluation of fetal well-being?". Am J Physiol Regul Integr Comp Physiol 2021; 320:R469-R470. [PMID: 33793343 DOI: 10.1152/ajpregu.00024.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Christopher A Lear
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Jenny A Westgate
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Michi Kasai
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand.,Department of Obstetrics and Gynecology, Yokohama City University, Yokohama, Japan
| | - Michael J Beacom
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Yoshiki Maeda
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand.,Department of Obstetrics and Gynecology, Mie University, Mie, Japan
| | - Shoichi Magawa
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand.,Department of Obstetrics and Gynecology, Mie University, Mie, Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University, Yokohama, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University, Mie, Japan
| | - Laura Bennet
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Alistair J Gunn
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
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