Original ArticlePreferential Cephalic Redistribution of Left Ventricular Cardiac Output during Therapeutic Hypothermia for Perinatal Hypoxic-Ischemic Encephalopathy
Section snippets
Methods
Newborns admitted to the Neonatal Intensive Care Unit of the Children's & Women's Health Centre of British Columbia (Canada) and treated with whole-body therapeutic hypothermia for moderate or severe HIE (based on the Sarnat staging system14) were prospectively enrolled between January 2009 and June 2010, following parental informed consent. Newborns were started on therapeutic hypothermia within 6 hours of life according to our institutional standards of presentation with moderate or severe
Results
Newborns treated with therapeutic hypothermia were comparable with the healthy term-born newborns with regard to their birth weight (mean ± SD 3.49 ± 0.52 vs 3.54 ± 0.43 kg; P = .78). The clinical markers of severity of the HIE in newborns are detailed in Table I. Moderate (n = 15) or severe HIE (n = 1) was diagnosed in all 16 newborns, of whom 13 had seizures (diagnosed by combination of clinical signs and cerebral function monitor changes). None of the newborns died before the rewarming was
Discussion
Using echocardiography, we document the hemodynamic changes occurring in the systemic and cerebral circulation in newborns with HIE undergoing whole-body therapeutic hypothermia. For comparison, we performed the same measures in a reference group of healthy term newborns without signs of HIE. Our data indicate a significant reduction in LVCO during therapeutic hypothermia, to almost 60% of values observed in healthy newborns. When comparing measures of systemic (LVCO) and cephalic (SVC) blood
References (29)
- et al.
Vasoparalysis associated with brain damage in asphyxiated term infants
J Pediatr
(1990) - et al.
Changes in cerebral hemodynamics and amplitude integrated EEG in an asphyxiated newborn during and after cool cap treatment
Brain Dev
(2009) Functional echocardiography in assessment of the cardiovascular system in asphyxiated neonates
J Pediatr
(2011)- et al.
Left ventricular Tei index in children: comparison of tissue Doppler imaging, pulsed wave Doppler, and M-mode echocardiography normal values
J Am Soc Echocardiogr
(2006) - et al.
Assessment of brain tissue injury after moderate hypothermia in neonates with hypoxic-ischaemic encephalopathy: a nested substudy of a randomised controlled trial
Lancet Neurol
(2010) - et al.
Early brain injury in premature newborns detected with magnetic resonance imaging is associated with adverse early neurodevelopmental outcome
J Pediatr
(2005) - et al.
Correlation between echocardiographic superior vena cava flow and short-term outcome in infants with asphyxia
Early Hum Dev
(2013) - et al.
Cerebral blood volume combined with amplitude-integrated EEG can be a suitable guide to control hypoxic/ischemic insult in a piglet model
Brain Dev
(2013) - et al.
Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial
Lancet
(2005) - et al.
No cry at birth: global estimates of intrapartum stillbirths and intrapartum-related neonatal deaths
Bull World Health Organ
(2005)
Long-term cognitive and behavioral consequences of neonatal encephalopathy following perinatal asphyxia: a review
Eur J Pediatr
Does perinatal asphyxia impair cognitive function without cerebral palsy?
Arch Dis Child Fetal Neonatal Ed
Cardiovascular dysfunction in infants with neonatal encephalopathy
Arch Dis Child
Neurological outcomes at 18 months of age after moderate hypothermia for perinatal hypoxic ischaemic encephalopathy: synthesis and meta-analysis of trial data
BMJ
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P.L. is support by a Clinician-Scientist Award from the Child & Family Research Institute and a Career Investigator Award from the Michael Smith Foundation for Health Research. S.M. is supported by the Bloorview Children's Hospital Chair in Pediatric Neuroscience, with previous support from a Canada Research Chair (Tier 2) and Michael Smith Foundation for Health Research Scholar award. The authors declare no conflicts of interest.