1. Electrocardiographic and echocardiographic changes during therapeutic hypothermia in encephalopathic infants with long-term adverse outcome.
- Author
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Montaldo P, Cuccaro P, Caredda E, Pugliese U, De Vivo M, Orbinato F, Magri D, Rojo S, Rosso R, Santantonio A, Vitiello R, Vacchiano T, Chello G, Del Giudice EM, and Giliberti P
- Subjects
- Echocardiography methods, Electrocardiography methods, Female, Humans, Infant, Newborn, Long Term Adverse Effects diagnosis, Longitudinal Studies, Male, Nervous System Diseases diagnosis, Nervous System Diseases epidemiology, Nervous System Diseases etiology, Outcome Assessment, Health Care, Prospective Studies, Severity of Illness Index, Vena Cava, Superior physiopathology, Asphyxia Neonatorum complications, Cardiac Output, Cerebrovascular Circulation, Hypothermia, Induced adverse effects, Hypothermia, Induced methods, Hypoxia-Ischemia, Brain diagnosis, Hypoxia-Ischemia, Brain etiology, Hypoxia-Ischemia, Brain mortality, Hypoxia-Ischemia, Brain therapy, Rewarming methods, Stroke Volume
- Abstract
Aim: To assess the electrocardiography and echocardiography changes during therapeutic hypothermia and rewarming period in encephalopathic infants with long-term adverse neurological outcome., Methods: Prospective multicentre longitudinal study. We included 64 consecutive infants with moderate or severe hypoxic ischaemic encephalopathy undergoing therapeutic hypothermia who had 18-24 month-outcome data. We analysed electrocardiography and heart rate changes before, during and after therapeutic hypothermia. Superior vena cava flow, left ventricular cardiac output and stroke volume were studied using echocardiography during and immediately after therapeutic hypothermia. An abnormal outcome was defined as death or moderate/severe disability at 18-24 months., Results: Neonates with higher superior vena cava flow pre-rewarming had significantly higher odds of documented long-term adverse outcome when compared to newborns with good outcome (OR 1.57; 95%CI, 1.1-1.78; p = 0.01 after adjustment). QTc and RR intervals were significantly longer at 12, 24, 36 and 48 h in infants with good outcome compared with those with adverse outcome (p < 0.001). During therapeutic hypothermia, infants with poor outcome had a higher heart rate at 12, 24, 36, 48, 60 h after birth compared with those with good outcome (p < 0.001). From 36 h on, heart rate gradually increased and RR and QTc intervals progressively shortened with values back to normal after rewarming., Conclusions: Infants with hypoxic ischaemic encephalopathy who have adverse neurological outcome show a preferential cerebral blood flow redistribution during therapeutic hypothermia. Infants with poor outcome have higher heart rate and shorter RR and QTc intervals during therapeutic hypothermia., (Copyright © 2018 Elsevier B.V. All rights reserved.)
- Published
- 2018
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