Hemodynamic Changes During Rewarming Phase of Whole-Body Hypothermia Therapy in Neonates with Hypoxic-Ischemic Encephalopathy

Tai-Wei Wu; Benita Tamrazi; Sadaf Soleymani; Istvan Seri; Shahab Noori

doi:10.1016/j.jpeds.2018.01.067

Hemodynamic Changes During Rewarming Phase of Whole-Body Hypothermia Therapy in Neonates with Hypoxic-Ischemic Encephalopathy

J Pediatr. 2018 Jun:197:68-74.e2. doi: 10.1016/j.jpeds.2018.01.067. Epub 2018 Mar 20.

Authors

Tai-Wei Wu¹, Benita Tamrazi², Sadaf Soleymani³, Istvan Seri⁴, Shahab Noori³

Affiliations

¹ Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Los Angeles, CA; Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA. Electronic address: twu@chla.usc.edu.
² Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA.
³ Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Los Angeles, CA; Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA.
⁴ Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA; First Department of Pediatrics, Faculty of Medicine, Semmelweis University, Budapest, Hungary.

PMID: 29571928
DOI: 10.1016/j.jpeds.2018.01.067

Abstract

Objective: To delineate the systemic and cerebral hemodynamic response to incremental increases in core temperature during the rewarming phase of therapeutic hypothermia in neonatal hypoxic-ischemic encephalopathy (HIE).

Study design: Continuous hemodynamic data, including heart rate (HR), mean arterial blood pressure (MBP), cardiac output by electrical velocimetry (CO_EV), arterial oxygen saturation, and renal (RrSO₂) and cerebral (CrSO₂) regional tissue oxygen saturation, were collected from 4 hours before the start of rewarming to 1 hour after the completion of rewarming. Serial echocardiography and transcranial Doppler were performed at 3 hours and 1 hour before the start of rewarming (T-3 and T-1; "baseline") and at 2, 4, and 7 hours after the start of rewarming (T+2, T+4, and T+7; "rewarming") to determine Cardiac output by echocardiography (CO_echo), stroke volume, fractional shortening, and middle cerebral artery (MCA) flow velocity indices. Repeated-measures analysis of variance was used for statistical analysis.

Results: Twenty infants with HIE were enrolled (mean gestational age, 38.8 ± 2 weeks; mean birth weight, 3346 ± 695 g). During rewarming, HR, CO_echo, and CO_EV increased from baseline to T+7, and MBP decreased. Despite an increase in fractional shortening, stroke volume remained unchanged. RrSO₂ increased, and renal fractional oxygen extraction (FOE) decreased. MCA peak systolic flow velocity increased. There were no changes in CrSO₂ or cerebral FOE.

Conclusions: In neonates with HIE, CO significantly increases throughout rewarming. This is due to an increase in HR rather than stroke volume and is associated with an increase in renal blood flow. The lack of change in cerebral tissue oxygen saturation and extraction, in conjunction with an increase in MCA peak systolic velocity, suggests that cerebral flow metabolism coupling remained intact during rewarming.

Keywords: asphyxia; blood flow; brain injury; echocardiography; electrical velocimetry; hemodynamics; hypothermia; newborn; rewarm.

Publication types

Observational Study

MeSH terms

Cerebrovascular Circulation / physiology
Echocardiography
Female
Hemodynamics / physiology*
Humans
Hypothermia, Induced / methods*
Hypoxia-Ischemia, Brain / physiopathology
Hypoxia-Ischemia, Brain / therapy*
Infant, Newborn
Magnetic Resonance Imaging
Male
Prospective Studies
Rewarming / methods*
Ultrasonography, Doppler, Transcranial