Impaired cerebral autoregulation in a newborn with congenital pneumonia, pneumothorax, and metabolic instability

Background. Severe perinatal asphyxia in newborns is often accompanied by a complex of interrelated disorders: congenital pneumonia, pneumothorax, metabolic instability, myocardial dysfunction, and seizures. The role of seizures as an independent factor affecting cerebral blood flow is systematically underestimated when interpreting neurosonography data.

Objective: to perform a systemic analysis of the influence of inflammation, pneumothorax, metabolic disturbances, and myocardial dysfunction on cerebral autoregulation in a newborn with severe asphyxia, with an assessment of seizures as a factor complicating the interpretation of the resistance index (RI).

Study design. Descriptive clinical case report with qualitative systemic analysis. Materials and methods. A clinical case of a full-term newborn with severe asphyxia, seizures in the first hour of life, congenital pneumonia, pneumothorax, hypoglycemia/hyperglycemia, and transient myocardial ischemia is presented. The dynamics of RI, laboratory markers, and brain magnetic resonance imaging (MRI) findings were analyzed.

Results. The patient demonstrated an increase in RI to 0.86 against the background of seizures, inflammation (C-reactive protein up to 5.99 mg/L), pneumothorax, glycemic fluctuations (2.4–12.9 mmol/L), and decreased cardiac output (168 mL/kg/min). Brain MRI revealed no structural changes, indicating a transient functional breakdown of cerebral autoregulation. Seizures are considered an independent factor hindering unambiguous interpretation of RI.

Conclusion. An increased RI in newborns with severe asphyxia is not a specific marker of irreversible ischemia. It may reflect a transient disintegration of autoregulation under the influence of a combination of factors. Normal MRI confirms the functional nature of the disturbances. All statements are hypothetical and require verification in prospective studies.

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