Journal article
Impaired Right Ventricular Performance Is Associated with Adverse Outcome after Hypoxic Ischemic Encephalopathy
American journal of respiratory and critical care medicine, Vol.200(10), pp.1294-1305
11/15/2019
DOI: 10.1164/rccm.201903-0583OC
PMID: 31251076
Abstract
Rationale: Asphyxiated neonates with hypoxic ischemic encephalopathy (HIE) are at risk of myocardial dysfunction; however, echocardiography studies are limited and little is known about the relationship between hemodynamics and brain injury.Objectives: To analyze the association between severity of myocardial dysfunction and adverse outcome as defined by the composite of death and/or abnormal magnetic resonance imaging.Methods: Neonates with HIE undergoing therapeutic hypothermia were enrolled. Participants underwent echocardiography at 24 hours, 72 hours (before rewarming), and 96 hours (after rewarming). Cerebral hemodynamics were monitored by near-infrared spectroscopy and middle cerebral artery Doppler.Measurements and Main Results: Fifty-three patients with a mean gestation and birthweight of 38.8 ± 2.0 weeks and 3.33 ± 0.6 kg, respectively, were recruited. Thirteen patients (25%) had mild encephalopathy, 27 (50%) had moderate encephalopathy, and 13 (25%) had severe encephalopathy. Eighteen patients (34%) had an adverse outcome. Severity of cardiovascular illness (P < 0.001) and severity of neurologic insult (P = 0.02) were higher in neonates with adverse outcome. Right ventricle (RV) systolic performance at 24 hours was substantially lower than published normative data in all groups. At 24 hours, lower tricuspid annular plane systolic excursion (P = 0.004) and RV fractional area change (P < 0.001), but not pulmonary hypertension, were independently associated with adverse outcome on logistic regression. High brain regional oxygen saturation (P = 0.007) and low middle cerebral artery resistive index (P = 0.04) were associated with RV dysfunction on post hoc analysis.Conclusions: RV dysfunction is associated with the risk of adverse outcome in asphyxiated patients with HIE undergoing hypothermia. Echocardiography may be a valuable diagnostic and prognostic tool in this vulnerable population.
Details
- Title: Subtitle
- Impaired Right Ventricular Performance Is Associated with Adverse Outcome after Hypoxic Ischemic Encephalopathy
- Creators
- Regan E Giesinger - Division of Neonatology and, Department of Paediatrics andAmr I El Shahed - Division of Neonatology and, Department of Paediatrics andMichael P Castaldo - Division of Neonatology andColm R Breatnach - Department of Paediatrics, The Rotunda Hospital, Dublin, Ireland; andVann Chau - Department of Paediatrics andHilary E Whyte - Division of Neonatology and, Department of Paediatrics andAfif F El-Khuffash - Department of Paediatrics, The Rotunda Hospital, Dublin, Ireland; and, Department of Paediatrics, School of Medicine, Royal College of Surgeons in Ireland, Dublin, IrelandLuc Mertens - Division of Cardiology, The Hospital for Sick Children, Toronto, Ontario, CanadaPatrick J McNamara - Division of Neonatology and, Department of Paediatrics and, Department of Physiology, The University of Toronto, Toronto, Ontario, Canada
- Resource Type
- Journal article
- Publication Details
- American journal of respiratory and critical care medicine, Vol.200(10), pp.1294-1305
- DOI
- 10.1164/rccm.201903-0583OC
- PMID
- 31251076
- ISSN
- 1073-449X
- eISSN
- 1535-4970
- Language
- English
- Date published
- 11/15/2019
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology; Internal Medicine
- Record Identifier
- 9984093463102771
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