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Neurodevelopmental outcome following hypoxic ischaemic encephalopathy and therapeutic hypothermia is related to right ventricular performance at 24-hour postnatal age
  1. Regan E Giesinger1,2,
  2. Amr I El Shahed3,4,
  3. Michael P Castaldo3,4,
  4. Adrianne R Bischoff1,2,
  5. Vann Chau4,5,
  6. Hilary E A Whyte3,4,
  7. Afif Faisal El-Khuffash6,
  8. Luc Mertens4,7,
  9. Patrick J McNamara1,2,8
  1. 1 Pediatrics, University of Iowa, Iowa City, Iowa, USA
  2. 2 Neonatology, Stead Family Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
  3. 3 Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
  4. 4 Pediatrics, University of Toronto, Toronto, Ontario, Canada
  5. 5 Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
  6. 6 Neonatology, The Rotunda Hospital, Dublin, Ireland
  7. 7 Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
  8. 8 Internal Medicine, University of Iowa, Iowa City, Iowa, USA
  1. Correspondence to Dr Patrick J McNamara, Pediatrics, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA 52242, USA; patrick-mcnamara{at}uiowa.edu

Abstract

Objective Our aim was to determine whether right ventricular (RV) dysfunction at 24-hour postnatal age predicts adverse developmental outcome among patients with hypoxic ischaemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH).

Design Neonates≥35 weeks with HIE/TH were enrolled in a physiological study in the neonatal period (n=46) and either died or underwent neurodevelopmental follow-up at 18 months (n=43). The primary outcome was a composite of death, diagnosis of cerebral palsy or any component of the Bayley Scores of Infant Development III<70. We hypothesised that tricuspid annulus plane systolic excursion (TAPSE) <6 mm and/or RV fractional area change (RV-FAC) <0.29 would predict adverse outcome.

Results Nine patients died and 34 patients were followed up at a mean age of 18.9±1.4 months. Both indices of RV systolic performance were abnormal in 15 (35%) patients, TAPSE <6 mm only was abnormal in 4 (9%) patients and RV-FAC <0.29 only was abnormal in 5 (12%) patients (19 had with normal RV function). Although similar at admission, neonates with RV dysfunction had higher cardiovascular and neurological illness severity by 24 hours than those without and severe MRI abnormalities (70% vs 53%, p=0.01) were more common. On logistic regression, TAPSE <6 mm (OR 3.6, 95% CI 1.2 to 10.1; p=0.017) and abnormal brain MRI [OR 21.7, 95% CI 1.4 to 336; p=0.028) were independently associated with adverse outcome. TAPSE <6 mm predicted outcome with a 91% sensitivity and 81% specificity.

Conclusions The role of postnatal cardiovascular function on neurological outcomes among patients with HIE who receive TH merits further study. Quantitative measurement of RV function at 24 hours may provide an additional neurological prognostic tool.

  • neonatology
  • neurology
  • cardiology

Data availability statement

Data are available on reasonable request. Data used to generate the conclusions in this work are available as supplementary materials. For discussion of further data, please contact the corresponding author.

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Data availability statement

Data are available on reasonable request. Data used to generate the conclusions in this work are available as supplementary materials. For discussion of further data, please contact the corresponding author.

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Footnotes

  • Twitter @afif_elkhuffash

  • Contributors REG: design, data collection, analysis, first draft of the manuscript, revisions of the manuscript. AE: data collection, revisions of manuscript. MPC: data collection, revisions of manuscript. ARB: data collection, revisions of manuscript. VC: design, interpretation, revisions of manuscript. HEAW: design, interpretation, revisions of manuscript. AFE-K: design, analysis, revisions of manuscript. LM: design, interpretation, revisions of manuscript. PJM: design, interpretation, revisions of the manuscript. All authors provided final approval of the version to be published and agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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