Electrocardiographic and echocardiographic changes during therapeutic hypothermia in encephalopathic infants with long-term adverse outcome

Autor: Umberto Pugliese, Silvana Rojo, Giovanni Chello, Elisabetta Caredda, Renato Vitiello, Teresa Vacchiano, Roberto Rosso, Francesco Orbinato, Pasquale Cuccaro, Paolo Giliberti, Alfredo Santantonio, Emanuele Miraglia del Giudice, Paolo Montaldo, Daniela Magri, Massimiliano De Vivo
Přispěvatelé: Montaldo, Paolo, Cuccaro, Pasquale, Caredda, Elisabetta, Pugliese, Umberto, De Vivo, Massimiliano, Orbinato, Francesco, Magri, Daniela, Rojo, Silvana, Rosso, Roberto, Santantonio, Alfredo, Vitiello, Renato, Vacchiano, Teresa, Chello, Giovanni, Del Giudice, Emanuele Miraglia, Giliberti, Paolo
Rok vydání: 2018
Předmět:
Male
Long Term Adverse Effects
Longitudinal Studie
Long Term Adverse Effect
030204 cardiovascular system & hematology
Emergency Nursing
Severity of Illness Index
Electrocardiography
0302 clinical medicine
Hypothermia
Induced
Outcome Assessment
Health Care
Therapeutic hypothermia
Longitudinal Studies
Prospective Studies
Cardiac Output
Nervous System Disease
Asphyxia Neonatorum
medicine.diagnostic_test
Stroke volume
Cerebral blood flow
Echocardiography
Cerebrovascular Circulation
Hypoxia-Ischemia
Brain
Hypoxic–ischaemic encephalopathy
Emergency Medicine
Cardiology
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
Human
medicine.medical_specialty
Vena Cava
Superior
Neonatal encephalopathy
QT interval
Outcome Assessment (Health Care)
03 medical and health sciences
Superior vena cava
030225 pediatrics
Internal medicine
Heart rate
medicine
Humans
Rewarming
business.industry
Infant
Newborn
Stroke Volume
Hypothermia
medicine.disease
Prospective Studie
Nervous System Diseases
business
Zdroj: Resuscitation. 130
ISSN: 1873-1570
Popis: 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.
Databáze: OpenAIRE
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