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Non-invasive Optical Measurement of Cerebral Metabolism and Hemodynamics in Infants
11:39

Non-invasive Optical Measurement of Cerebral Metabolism and Hemodynamics in Infants

Published on: March 14, 2013

21.1K

Electrocardiographic and echocardiographic changes during therapeutic hypothermia in encephalopathic infants with

Paolo Montaldo1, Pasquale Cuccaro2, Elisabetta Caredda3

  • 1Department of Neonatal Intensive Care, University of Campania "Luigi Vanvitelli", Naples, Italy; Centre for Perinatal Neuroscience, Imperial College London, London, UK.

Resuscitation
|July 17, 2018
PubMed

Insights

Infants undergoing therapeutic hypothermia for hypoxic-ischaemic encephalopathy with poor neurological outcomes showed altered heart rate and cardiac flow patterns. These changes during cooling and rewarming may indicate a preferential cerebral blood flow redistribution.

Area of Science:

  • Neonatal cardiology
  • Pediatric neurology
  • Critical care medicine

Background:

  • Therapeutic hypothermia (TH) is a standard treatment for neonatal hypoxic-ischaemic encephalopathy (HIE).
  • Long-term neurological outcomes in infants with HIE vary significantly.
  • Electrocardiography (ECG) and echocardiography can provide insights into cardiovascular adaptation during TH.

Purpose of the Study:

  • To evaluate ECG and echocardiography changes in infants with HIE during TH and rewarming.
  • To correlate these cardiovascular changes with long-term neurological outcomes.
  • To identify potential biomarkers for predicting adverse neurological outcomes.

Main Methods:

  • Prospective, multicentre longitudinal study of 64 infants with moderate/severe HIE undergoing TH.
  • Analysis of ECG (QTc, RR intervals) and heart rate before, during, and after TH.
  • Echocardiography assessed superior vena cava (SVC) flow, cardiac output, and stroke volume during and after TH.
  • Long-term neurological outcome assessed at 18-24 months (death or moderate/severe disability).

Main Results:

  • Higher SVC flow pre-rewarming was associated with significantly higher odds of adverse long-term outcome (OR 1.57; p=0.01).
  • Infants with good outcomes had significantly longer QTc and RR intervals compared to those with adverse outcomes (p<0.001).
  • Infants with poor outcomes exhibited higher heart rates during TH (p<0.001), with gradual heart rate increase and interval shortening upon rewarming.

Conclusions:

  • Adverse neurological outcomes in HIE infants undergoing TH are linked to altered cardiovascular parameters.
  • Higher heart rate and shorter RR/QTc intervals during TH may indicate poor outcomes.
  • These findings suggest a potential role for cardiovascular monitoring in predicting neurological outcomes after HIE.
Abstract

Keywords:
EchocardiographyElectrocardiographyHypoxic–ischaemic encephalopathyNeonatal encephalopathyTherapeutic hypothermia

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