Gastrointestinal hemodynamic changes during therapeutic hypothermia and after rewarming in neonatal hypoxic-Ischemic encephalopathy

Pankaj Sakhuja; Kiran More; Joseph Y Ting; Jesal Sheth; Annie Lapointe; Amish Jain; Patrick J McNamara; Aideen M Moore

doi:10.1016/j.pedneo.2019.04.003

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Gastrointestinal hemodynamic changes during therapeutic hypothermia and after rewarming in neonatal hypoxic-Ischemic encephalopathy

Journal article

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Peer reviewed

Gastrointestinal hemodynamic changes during therapeutic hypothermia and after rewarming in neonatal hypoxic-Ischemic encephalopathy

Pankaj Sakhuja, Kiran More, Joseph Y Ting, Jesal Sheth, Annie Lapointe, Amish Jain, Patrick J McNamara and Aideen M Moore

Pediatrics and neonatology, Vol.60(6), pp.669-675

12/2019

DOI: 10.1016/j.pedneo.2019.04.003

PMID: 31109892

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Abstract

Hypoxic-ischemic encephalopathy (HIE) is associated with disturbances in visceral blood flow velocities. Therapeutic Hypothermia (TH) is a standard of care; however, its impact on gastrointestinal blood flow in infants with HIE is unknown. The objective of this study was to assess gastrointestinal (GI) blood flow and left ventricle output (LVO) in infants with hypoxic-ischemic encephalopathy during whole body TH and after rewarming. Serial echocardiography and Doppler evaluation of intestinal blood flow (celiac (CA) and superior mesenteric (SMA) arteries) were prospectively performed in a cohort of 20 newborn infants with HIE at 4 time points during hypothermia and after rewarming. Demographic, clinical and biochemical data were collected and analyzed for their relevance. Median gestational age and birth weight was 40 weeks (37–41) and 3410 g (2190–4950) respectively. Celiac and mesenteric artery flow remained low during hypothermia and rose significantly after rewarming [peak systolic velocity in CA (0.63 m/s to 0.77 m/s, p = 0.004) and SMA (0.43 m/s to 0.55 m/s, p = 0.001)]. This increase was temporally associated with increased left ventricular output (106 ml/kg/min to 149 ml/kg/min, p < 0.0001). Median age to reach 25% of the feeds was 5 days (1–7 days). All patients survived. CA and SMA blood flow velocity and LVO did not vary during hypothermia but rose after rewarming. This may suggest protective effect of therapeutic hypothermia on gastrointestinal system. The association of these physiological changes with neonatal outcome needs further assessment.

celiac artery

superior mesentery artery

therapeutic hypothermia

hemodynamic changes

Details

Title: Subtitle: Gastrointestinal hemodynamic changes during therapeutic hypothermia and after rewarming in neonatal hypoxic-Ischemic encephalopathy
Creators: Pankaj Sakhuja - Division of Neonatology, The Hospital for Sick Children, Toronto, Canada
Kiran More - Division of Neonatology, The Hospital for Sick Children, Toronto, Canada
Joseph Y Ting - Department of Pediatrics, University of British Columbia, Vancouver, Canada
Jesal Sheth - Fortis Hospital, Mumbai, India
Annie Lapointe - Ste-Justine Hospital, Montreal, Canada
Amish Jain - Division of Neonatology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
Patrick J McNamara - Division of Neonatology, The Hospital for Sick Children, Toronto, Canada
Aideen M Moore - Division of Neonatology, The Hospital for Sick Children, Toronto, Canada
Resource Type: Journal article
Publication Details: Pediatrics and neonatology, Vol.60(6), pp.669-675
DOI: 10.1016/j.pedneo.2019.04.003
PMID: 31109892
NLM abbreviation: Pediatr Neonatol
ISSN: 1875-9572
eISSN: 2212-1692
Publisher: Elsevier B.V
Language: English
Date published: 12/2019
Academic Unit: Stead Family Department of Pediatrics; Neonatology; Internal Medicine
Record Identifier: 9984093472002771

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