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Am J Perinatol. 2018 Aug;35(10):979-989. doi: 10.1055/s-0038-1629900. Epub 2018 Feb 23.

Cardiovascular Associations with Abnormal Brain Magnetic Resonance Imaging in Neonates with Hypoxic Ischemic Encephalopathy Undergoing Therapeutic Hypothermia and Rewarming.

Author information

1
Department of Neonatology, Christchurch Women's Hospital, Canterbury, New Zealand.
2
Department of Paediatrics, King Hamad University Hospital, Busaiteen, Bahrain.
3
Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada.
4
Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada.
5
Children's & Women's Health Centre of British Columbia, Vancouver, British Columbia, Canada.
6
Department of Neonatology, Fortis Hospital, Mumbai, Maharashtra, India.
7
Department of Neonatology, Sainte-Justine Hospital, Montreal, Canada.
8
Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.
9
Department of Physiology, The University of Toronto, Toronto, Ontario, Canada.

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.

PMID:
29475200
DOI:
10.1055/s-0038-1629900

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