Preferential cephalic redistribution of left ventricular cardiac output during therapeutic hypothermia for perinatal hypoxic-ischemic encephalopathy

Patrick J McNamara; Ori Hochwald; Mohammad Jabr; Horacio Osiovich; Steven P Miller; Pascal M Lavoie

doi:10.1016/j.jpeds.2014.01.028

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Preferential cephalic redistribution of left ventricular cardiac output during therapeutic hypothermia for perinatal hypoxic-ischemic encephalopathy

Journal article

Peer reviewed

Preferential cephalic redistribution of left ventricular cardiac output during therapeutic hypothermia for perinatal hypoxic-ischemic encephalopathy

Patrick J McNamara, Ori Hochwald, Mohammad Jabr, Horacio Osiovich, Steven P Miller and Pascal M Lavoie

The Journal of pediatrics, Vol.164(5), pp.999-1004.e1

05/2014

DOI: 10.1016/j.jpeds.2014.01.028

PMCID: PMC4623763

PMID: 24582011

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Abstract

To determine the relationship between left ventricular cardiac output (LVCO), superior vena cava (SVC) flow, and brain injury during whole-body therapeutic hypothermia. Sixteen newborns with moderate or severe hypoxic-ischemic encephalopathy were studied using echocardiography during and immediately after therapeutic hypothermia. Measures were also compared with 12 healthy newborns of similar postnatal age. Newborns undergoing therapeutic hypothermia also had cerebral magnetic resonance imaging as part of routine clinical care on postnatal day 3-4. LVCO was markedly reduced (mean ± SD 126 ± 38 mL/kg/min) during therapeutic hypothermia, whereas SVC flow was maintained within expected normal values (88 ± 27 mL/kg/min) such that SVC flow represented 70% of the LVCO. The reduction in LVCO during therapeutic hypothermia was mainly accounted by a reduction in heart rate (99 ± 13 vs 123 ± 17 beats/min; P < .001) compared with immediately postwarming in the context of myocardial dysfunction. Neonates with brain injury on magnetic resonance imaging had higher SVC flow prerewarming, compared with newborns without brain injury (P = .013). Newborns with perinatal hypoxic-ischemic encephalopathy showed a preferential systemic-to-cerebral redistribution of cardiac blood flow during whole-body therapeutic hypothermia, which may reflect a lack of cerebral vascular adaptation in newborns with more severe brain injury.

Magnetic Resonance Imaging

Severity of Illness Index

Heart Rate

Infant, Premature, Diseases - physiopathology

Prospective Studies

Humans

Cardiac Output

Male

Treatment Outcome

Infant, Premature, Diseases - therapy

Brain Injuries - physiopathology

Case-Control Studies

Brain Injuries - diagnosis

Hypoxia-Ischemia, Brain - diagnostic imaging

Hypothermia, Induced - methods

Infant, Premature

Infant, Premature, Diseases - diagnostic imaging

Female

Hypoxia-Ischemia, Brain - therapy

Ultrasonography, Doppler, Pulsed

Brain Injuries - etiology

Infant, Newborn

Hypoxia-Ischemia, Brain - physiopathology

Details

Title: Subtitle: Preferential cephalic redistribution of left ventricular cardiac output during therapeutic hypothermia for perinatal hypoxic-ischemic encephalopathy
Creators: Patrick J McNamara - Division of Neonatology, Department of Pediatrics, Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
Ori Hochwald - Neonatal Intensive Care Unit, Rambam Medical Center, Haifa, Israel
Mohammad Jabr - Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, Canada
Horacio Osiovich - Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, Canada
Steven P Miller - Division of Neurology, Department of Pediatrics, Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
Pascal M Lavoie - Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, Canada
Resource Type: Journal article
Publication Details: The Journal of pediatrics, Vol.164(5), pp.999-1004.e1
DOI: 10.1016/j.jpeds.2014.01.028
PMID: 24582011
PMCID: PMC4623763
NLM abbreviation: J Pediatr
ISSN: 0022-3476
eISSN: 1097-6833
Grant note: 85560-1 / Canadian Institutes of Health Research
Language: English
Date published: 05/2014
Academic Unit: Stead Family Department of Pediatrics; Neonatology; Internal Medicine
Record Identifier: 9984093606302771

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