Hemodynamics Among Neonates With Hypoxic-Ischemic Encephalopathy During Whole-Body Hypothermia and Passive Rewarming

Gebauer, Corinna; Knuepfer, Matthias; Robel-Tillig, E.; Pulzer, F.; Vogtmann, C

doi:10.1542/peds.2004-1587

Cited by 106 publications

(84 citation statements)

References 35 publications

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“…In a recent study examining the cardiac hemodynamic effect of whole-body TH in newborns with HIE, using echocardiography, authors concluded that left ventricular cardiac output (LVCO) is reduced by about 67% during TH when compared to measures obtained after rewarming. This suggests that TH may limit the extent of systemic blood flow available to vital organs, including the brain (10). However, a limitation of this latter study by Gebauer et al is the absence of measures of cerebral blood flow.…”

Section: Introductionmentioning

confidence: 87%

“…Newborns are generally able to maintain adequate blood pressure at low temperature achieved during TH (10,11). In a recent study examining the cardiac hemodynamic effect of whole-body TH in newborns with HIE, using echocardiography, authors concluded that left ventricular cardiac output (LVCO) is reduced by about 67% during TH when compared to measures obtained after rewarming.…”

Section: Introductionmentioning

confidence: 99%

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Preferential Cephalic Redistribution of Left Ventricular Cardiac Output during Therapeutic Hypothermia for Perinatal Hypoxic-Ischemic Encephalopathy

Hochwald

Jabr

Osiovich

et al. 2014

The Journal of Pediatrics

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Objective-To determine the relationship between left ventricular cardiac output (LVCO), superior vena cava (SVC) flow, and brain injury during whole-body therapeutic hypothermia.Study design-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 a cerebral magnetic resonance imaging as part of routine clinical care on postnatal day 3-4.Results-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 it represented 70% of the LVCO. The reduction in LVCO during therapeutic hypothermia was mainly accounted by a reduction in heart rate (99 +/− 13 BPM versus 123 +/− 17 BPM; p<0.001) compared to immediately post-warming, in the context of myocardial dysfunction. Neonates with documented brain injury on MRI showed higher SVC flow pre-rewarming, compared to newborns without brain injury (p=0.013).Conclusion-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.

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Section: Introductionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Preferential Cephalic Redistribution of Left Ventricular Cardiac Output during Therapeutic Hypothermia for Perinatal Hypoxic-Ischemic Encephalopathy

Hochwald

Jabr

Osiovich

et al. 2014

The Journal of Pediatrics

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“…Zhou et al did not fi nd signifi cant differences in cardiac functions between normothermic asphyxiated newborns and asphyxiated newborns treated with hypothermia (17). In another study including seven asphyxiated patients, it was shown that cardiac output was decreased as to 67 % of normal with whole-body hypothermia and passive rewarming (18). In two recent studies, Sehgal et al had found that global cardiac functions were low in infants undergoing hypothermia (19).…”

Section: Discussionmentioning

confidence: 97%

Therapeutic hypothermia and myocardium in perinatal asphyxia: a microvolt T-wave alternans and Doppler echocardiography study

Karpuz¹,

Çelik²,

Giray³

et al. 2018

BLL

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OBJECTIVES: This is the fi rst study evaluating the predictive value of myocardial performance on arrhythmia and mortality via tissue-Doppler and microvolt T-wave alternans in infants with hypoxic-ischemic encephalopathy treated with therapeutic hypothermia-rewarming. METHODS: The study included 23 term newborns having criteria for hypoxic-ischemic encephalopathy, and 12 controls. Tissue-Doppler imaging and T-wave alternans were performed in the fi rst six hours after birth in patients from both groups and after hypothermia-rewarming treatment on the fi fth day. RESULTS: The basal T-wave alternans values were higher in patients in lead aVF(p < 0.001) which also correlated with existing acidemia (r = 0.517; p = 0.012). Basal T-wave alternans and post-treatment values of patients were compared in leads V1 (p < 0.001) and aVF (p < 0.001); a signifi cant decrease was found on the fi fth day. Moreover, right ventricle diastolic diameter and estimated systolic pulmonary artery pressure of patients in the fi rst 6 hours were higher (p = 0.03, p < 0.001, respectively). Although, the ejection fraction of patients did not decrease, basal values of left and right ventricular systolic and diastolic functions were lower initially, and increased signifi cantly after treatment. CONCLUSION: The global cardiac functions and myocardial performance of newborns with hypoxic-ischemia might be improved with therapeutic hypothermia which can be determined by using T-wave alternans and tissueDoppler measurements. However, further studies are needed to assess whether these measurements are prognostic in determining the myocardial dysfunction and arrhythmias (Tab. 2, Fig. 3, Ref. 26). Text in PDF www.elis.sk.

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“…Data from these preliminary clinical studies indicated that reducing body temperature by 2°C to 3°C for a prolonged period of time was possible and that the changes in blood pressure, heart rate, and cardiac output noted were of little clinical significance. [5][6][7] Large Randomized Clinical Trials of Hypothermic Neural Rescue ( Table 1) Six large randomized clinical trials of induced hypothermia for neonatal encephalopathy were published from 2005 to 2011. [8][9][10][11][12][13] Although there were some differences in the method of cooling and selection of subjects, in all trials infants were at least 35 weeks' gestation at birth; randomization was completed within 6 hours of birth; the target temperature was 33.5°C to 34.5°C; the intervention period was 72 hours, followed by slow rewarming (0.5°C/hour); and the primary outcome measure was the combined rate of death or disability, assessed at 18 to 22 months of age.…”

Section: Preliminary Studiesmentioning

confidence: 99%

Hypothermia and Neonatal Encephalopathy

2014

Pediatrics

295

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Data from large randomized clinical trials indicate that therapeutic hypothermia, using either selective head cooling or systemic cooling, is an effective therapy for neonatal encephalopathy. Infants selected for cooling must meet the criteria outlined in published clinical trials. The implementation of cooling needs to be performed at centers that have the capability to manage medically complex infants. Because the majority of infants who have neonatal encephalopathy are born at community hospitals, centers that perform cooling should work with their referring hospitals to implement education programs focused on increasing the awareness and identification of infants at risk for encephalopathy, and the initial clinical management of affected infants.

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Hemodynamics Among Neonates With Hypoxic-Ischemic Encephalopathy During Whole-Body Hypothermia and Passive Rewarming

Abstract: Whole-body hypothermia resulted in reduced cardiac output, which reached normal levels at the end of passive rewarming, at normothermia. Physiologic cardiovascular mechanisms seemed to be intact to provide sufficient tissue perfusion, with normal blood lactate levels.

Cited by 106 publications

References 35 publications

Preferential Cephalic Redistribution of Left Ventricular Cardiac Output during Therapeutic Hypothermia for Perinatal Hypoxic-Ischemic Encephalopathy

Preferential Cephalic Redistribution of Left Ventricular Cardiac Output during Therapeutic Hypothermia for Perinatal Hypoxic-Ischemic Encephalopathy

Therapeutic hypothermia and myocardium in perinatal asphyxia: a microvolt T-wave alternans and Doppler echocardiography study

Hypothermia and Neonatal Encephalopathy

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