Journal article
Cardiovascular Associations with Abnormal Brain Magnetic Resonance Imaging in Neonates with Hypoxic Ischemic Encephalopathy Undergoing Therapeutic Hypothermia and Rewarming
American journal of perinatology, Vol.35(10), pp.979-989
08/2018
DOI: 10.1055/s-0038-1629900
PMID: 29475200
Abstract
Abstract
Objective
This article compares hemodynamic characteristics of neonates with hypoxic ischemic encephalopathy (HIE) receiving therapeutic hypothermia (TH) with normal versus abnormal brain magnetic resonance imaging (MRI).
Methods
Serial echocardiography (echo) was performed within 24 hours, after 48 to 72 hours of cooling, within 24 hours of normothermia, and after starting feeds. Pulmonary hemodynamics, cardiac output, and ventricular function were evaluated. All neonates underwent brain MRI (day 4–5), per clinical standard of care. Clinical cardiovascular and echocardiography characteristics were compared between patients with normal versus abnormal MRI. Cardiovascular changes during TH and after rewarming were identified.
Results
Twenty neonates at median gestation and birth weight of 40 weeks (interquartile range [IQR]: 39, 41) and 3,410 g (IQR: 2,885, 4,093), respectively, were enrolled. Increased median left ventricular output (LVO) (106–159 mL/kg/min,
p
< 0.001) and reduced isovolumic relaxation time (IVRT) (48–42 ms,
p
< 0.001) were seen after rewarming. Echocardiography evidence of pulmonary hypertension (PH) was identified in five neonates. Eight neonates (40%) had brain injury identified on MRI (watershed [
n
= 4], basal ganglia [
n
= 4]); this subgroup were more likely to have echo evidence of PH at 24 hours.
Conclusion
Longitudinal changes in cardiac output were noted in neonates with HIE during TH and rewarming. Echocardiography evidence of PH, however, was associated with abnormal MRI brain. The prognostic relevance of these physiologic changes requires more comprehensive delineation.
Details
- Title: Subtitle
- Cardiovascular Associations with Abnormal Brain Magnetic Resonance Imaging in Neonates with Hypoxic Ischemic Encephalopathy Undergoing Therapeutic Hypothermia and Rewarming
- Creators
- Regan E Giesinger - Department of Paediatrics, The University of Toronto, Toronto, Ontario, CanadaKiran S More - Department of Neonatology, Christchurch Women's Hospital, Canterbury, New ZealandPankaj Sakhuja - Department of Paediatrics, King Hamad University Hospital, Busaiteen, BahrainPatrick J McNamara - Department of Paediatrics, The Hospital for Sick ChildrenJoseph Y Ting - Children's & Women's Health Centre of British Columbia, Vancouver, British Columbia, CanadaMatthew Keyzers - Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, CanadaJesal N Sheth - Department of Neonatology, Fortis Hospital, Mumbai, Maharashtra, IndiaAnie Lapointe - Department of Neonatology, Sainte-Justine Hospital, Montreal, CanadaAmish Jain - Department of Physiology, The University of Toronto, Toronto, Ontario, CanadaAideen M Moore - Department of Paediatrics, The University of Toronto, Toronto, Ontario, CanadaSteven P Miller - Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada
- Resource Type
- Journal article
- Publication Details
- American journal of perinatology, Vol.35(10), pp.979-989
- Publisher
- Thieme Medical Publishers
- DOI
- 10.1055/s-0038-1629900
- PMID
- 29475200
- ISSN
- 0735-1631
- eISSN
- 1098-8785
- Language
- English
- Date published
- 08/2018
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology; Internal Medicine
- Record Identifier
- 9984093608202771
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