Cardiac function at follow-up in infants treated with therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy

Valérie Biran; Eliana Saba; Anie Lapointe; Carolina Michele Macias; Wadi Mawad; Daniela Villegas Martinez; Tíscar Cavallé-Garrido; Pia Wintermark; Gabriel Altit

doi:10.1038/s41390-024-03694-3

Cardiac function at follow-up in infants treated with therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy

Pediatr Res. 2024 Oct 31. doi: 10.1038/s41390-024-03694-3. Online ahead of print.

Authors

Affiliations

¹ Neonatology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada.
² Neonatal Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert Debré's Children Hospital, University Paris Cité, 75019, Paris, France.
³ I2D2, Inserm 1141, University Paris Cité, 75019, Paris, France.
⁴ Neonatology- CHU Ste-Justine- Université de Montréal, Montreal, QC, Canada.
⁵ Pediatric Cardiology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada.
⁶ Neonatology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada. [email protected].

^# Contributed equally.

PMID: 39482497
DOI: 10.1038/s41390-024-03694-3

Abstract

Background: Compromised myocardial function and persistent elevated pulmonary vascular resistance are common among neonates treated with therapeutic hypothermia (TH) for hypoxic-ischemic encephalopathy (HIE). There is a lack of data regarding persistence of cardiac alterations after discharge from the neonatal intensive care unit (NICU).

Methods: We assessed cardiovascular profiles after NICU discharge. Echocardiogram data, including speckle-tracking echocardiography (STE), were extracted from the latest outpatient scan. Data were compared by initial amplitude-integrated encephalography (aEEG) profiles on admission [normal vs. abnormal].

Results: In total, 70 (19%) neonates had a follow-up echocardiogram (22 with initial normal aEEG, 48 with abnormal aEEG). Age at follow-up was similar between the two groups (6.2 vs. 7.7 months, [p = 0.08]). Neonates with an initially abnormal aEEG showed more negative Right Ventricle (RV)-peak global longitudinal strain (-28.2 vs. -26.0%, [p = 0.02]), RV-peak free wall longitudinal strain rate (-1.24 vs. -1.10 [1/second], [p = 0.01]), and RV-peak free wall longitudinal strain rate (-1.50 vs. -1.27 [1/second], [p = 0.001]). These associations remained after multilinear regression analysis, indicating persistent enhanced RV contraction in the abnormal aEEG group.

Conclusion: Neonates with initial abnormal aEEG profiles exhibited increased RV contraction after NICU discharge. Future studies should explore long-term cardiovascular follow-up of neonates with HIE, beyond the perinatal period.

Impact: What is the key message of your article? Cardiac performance in hypoxic ischemic encephalopathy is linked to adverse outcomes. Survivors with an abnormal aEEG at admission showed increased right ventricular contractility at follow-up, possibly related to an adverse adaptation to the initial insult. What does it add to the existing literature? This study offers insights into long-term cardiovascular outcomes in neonates with HIE, focusing on the link between initial aEEG abnormalities and later RV function. What is the impact? The findings underscore the importance of early cardiovascular assessments and monitoring in neonates undergoing TH for HIE, potentially guiding future follow-up protocols.