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Biventricular function on early echocardiograms in neonatal hypoxic-ischaemic encephalopathy
Sanjeev Aggarwal1, Girija Natarajan1
1Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA.
Acta Paediatrica (Oslo, Norway : 1992)
|April 5, 2017
Summary
Infants with hypoxic-ischaemic encephalopathy (HIE) show ventricular dysfunction. Echocardiograms reveal differences in cardiac function between survivors and those who died, particularly in the eccentricity index of the left ventricle.
Area of Science:
- Neonatal cardiology
- Pediatric critical care
- Perinatal medicine
Background:
- Perinatal hypoxic-ischaemic encephalopathy (HIE) is a major cause of neonatal mortality and morbidity.
- Cardiac dysfunction is a recognized complication of HIE, but early echocardiographic findings require further characterization.
- Therapeutic hypothermia (TH) is a standard treatment for HIE, and its impact on cardiac function warrants investigation.
Purpose of the Study:
- To compare early echocardiographic (ECHOs) findings in infants with HIE undergoing therapeutic hypothermia (TH) or normothermia versus healthy controls.
- To assess biventricular function, pulmonary hypertension, and ductal shunting in infants with HIE.
- To identify echocardiographic predictors of mortality in infants with HIE.
Main Methods:
- Retrospective review of early (<24 hours) echocardiograms in term infants with moderate to severe HIE and controls.
- Comparison of right and left ventricular output (RVO, LVO), myocardial performance index (MPI), systolic/diastolic duration ratio (S/D), and eccentricity indices (EI).
- Statistical analysis using ANOVA to compare echocardiographic parameters between HIE groups (TH, normothermia) and controls.
Main Results:
- Infants with HIE exhibited significantly elevated biventricular MPI and lower RVO/LVO compared to controls.
- Pulmonary hypertension was more prevalent in HIE infants, indicated by abnormal EI, higher RV S/D, and ductal shunting.
- Left ventricular MPI was lower in the HIE-TH group than in the HIE-normothermia group. Survivors had a higher diastolic eccentricity index (EId) than non-survivors.
Conclusions:
- Perinatal HIE is associated with significant biventricular dysfunction and pulmonary hypertension.
- The diastolic eccentricity index (EId) may serve as a potential echocardiographic predictor of mortality in infants with HIE.
- Further validation is needed to confirm the prognostic value of EId in HIE.