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Cardiac Dysfunction in Neonatal HIE Is Associated with Increased Mortality and Brain Injury by MRI
Objective Describe the association between cardiac dysfunction and death or moderate-to-severe abnormalities on brain magnetic resonance imaging (MRI) in neonates undergoing therapeutic hypothermia for hypoxic ischemic encephalopathy (HIE).
Study Design Retrospective study in neonates with moderate or severe HIE undergoing therapeutic hypothermia between 2008 and 2017. Primary outcome was death or moderate-to-severe brain injury using the Barkovich score. Conventional and speckle-tracking echocardiography measures were extracted from available echocardiograms to quantify right (RV) and left (LV) ventricular functions.
Results A total of 166 newborns underwent therapeutic hypothermia of which 53 (36.5%) had echocardiography performed. Ten (19%) died prior to hospital discharge, and 11 (26%) had moderate-to-severe brain injury. There was no difference in chronologic age at echocardiography between the normal and adverse outcome groups (22 [±19] vs. 28 [±21] hours, p = 0.35). Cardiac findings in newborns with abnormal outcome included lower systolic and diastolic blood pressure (BP) at echocardiography (p = 0.004) and decreased tricuspid annular plane systolic excursion (a marker of RV systolic function; p = 0.01), while the ratio of systolic pulmonary artery (PA) pressure to systolic BP indicated isosystemic pressures (>2/3 systemic) in both groups. A multilogistic regression analysis, adjusting for weight and seizure status, indicated an association between abnormal outcome and LV function by longitudinal strain, as well as by ejection fraction.
Conclusion Newborns who died or had moderate–to-severe brain injury had a higher incidence of cardiac dysfunction but similar PA pressures when compared with those who survived with mild or no MRI abnormalities.
Newborns with HIE with functional LV/RV dysfunction are at risk for death or brain injury.
All neonates with HIE had elevated pulmonary pressure, but neonates with poor outcome had RV dysfunction.
When evaluating newborns with HIE by echocardiography, beyond estimation of pulmonary pressure, it is important to assess biventricular function.
Keywordshypoxic ischemic encephalopathy - brain injury - cardiac dysfunction - speckle tracking echocardiography - therapeutic hypothermia
The derived data generated in this research will be shared on reasonable request to the corresponding author.
This study was approved by the institutional review board of Stanford University (e-Protocol no.: IRB 41131).
G.A. conceptualized and designed the study, collected the data, extracted the data from echocardiography, analyzed the data, drafted the manuscript, and adjusted the manuscript according to the comments of the coauthors.
S.L.B. conceptualized and designed the study, collected the data (extracted data and scored brain magnetic resonance imaging), critically appraised the analysis of the data, and reviewed and revised the manuscript.
C.V.G. collected the data, helped with the data collection regarding brain magnetic resonance imaging, and revised the manuscript.
S.B. conceptualized and designed the study, critically appraised the analysis of the data, and reviewed and revised the manuscript.
G.S. collected the data, critically appraised the analysis, and revised the manuscript.
B.Y. collected the data, helped with the data collection regarding brain magnetic resonance imaging, critically appraised the analysis, and revised the manuscript.
V.C. conceptualized and designed the study, critically appraised the analysis of the data, and reviewed and revised the manuscript.
K.V.M. conceptualized and designed the study, supervised data collection, critically appraised the analysis of the data, and wrote and critically reviewed the manuscript for important intellectual content.
All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Received: 23 May 2021
Accepted: 09 August 2021
07 September 2021 (online)
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