Sehgal A, Linduska N, Huynh C
Monash Newborn, Monash Children's Hospital, Clayton, Australia.
Department of Pediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
J Neonatal Perinatal Med. 2019;12(2):117-125. doi: 10.3233/NPM-1853.
Hypoxic ischemic encephalopathy (HIE) affects one to two newborns per 1,000 live births and oftentimes involves multi-organ insult. The objectives were to assess the evolution of cardiac function in infants with HIE treated with therapeutic hypothermia using echocardiography (ECHO).
Archived data during the period 2010-2016 was assessed. Amongst the infants with baseline ECHO assessments, a sub-cohort which had assessments in all the three phases (baseline/pre-active cooling [T1], cooling [T2] and rewarming [T3]) was analyzed separately.
Thirty three infants formed part of the overall cohort, the gestation and birthweight were 39.6 ± 1.6 weeks and 3306 ± 583 g, respectively. Baseline (T1) information noted impaired cardiac performance (right ventricle stroke volume 1.08 ± 0.04 ml/kg, fractional area change [FAC] 24 ± 0.5% and tricuspid annular peak systolic excursion [TAPSE] 7.46 ± 0.11mm). Serial information was available for 24 of 33 infants. Cardiac function improved significantly between the cooling and the re-warming kphases. This included changes in right ventricular output (127 ± 34 vs 164 ± 47 ml/kg/min, p <0.01) and FAC (20 ± 3 vs 28 ± 2%, p<0.01). Pairwise comparisons for fractional shortening did not show significant changes. From the cooling to the rewarming phase, maximum change was noted in FAC (26.3 ± 9.8%) while minimum change was noted in fractional shortening (median, interquartile range) of 4.6% (1.4, 9.1). Significant correlation between TAPSE and time to peak velocity as a proportion of right ventricular ejection time was noted (r2 = 0.68, p <0.001).
In infants with moderate to severe HIE, cardiac function evolves during various phases of therapeutic hypothermia. Low output state during cooling may be due to a combination of the disease state (HIE) and cooling therapy.
缺氧缺血性脑病（HIE）在每1000例活产儿中影响1至2名新生儿，且常涉及多器官损伤。目的是使用超声心动图（ECHO）评估接受治疗性低温治疗的HIE婴儿的心功能演变。
评估2010 - 2016年期间的存档数据。在有基线ECHO评估的婴儿中，对在所有三个阶段（基线/主动降温前[T1]、降温[T2]和复温[T3]）均有评估的一个亚队列进行单独分析。
33名婴儿构成了整个队列，孕周和出生体重分别为39.6±1.6周和3306±583克。基线（T1）信息显示心功能受损（右心室每搏输出量1.08±0.04毫升/千克，面积变化分数[FAC]24±0.5%，三尖瓣环收缩期峰值位移[TAPSE]7.46±0.11毫米）。33名婴儿中有24名有连续信息。在降温阶段和复温阶段之间，心功能有显著改善。这包括右心室输出量的变化（127±34对164±47毫升/千克/分钟，p<0.01）和FAC（20±3对28±2%，p<0.01）。缩短分数的两两比较未显示出显著变化。从降温阶段到复温阶段，FAC变化最大（26.3±9.8%），而缩短分数变化最小（中位数，四分位间距）为4.6%（1.4，9.1）。观察到TAPSE与右心室射血时间峰值速度所占比例的时间之间存在显著相关性（r2 = 0.68，p<0.001）。
在中度至重度HIE婴儿中，心功能在治疗性低温的各个阶段都会发生演变。降温期间的心输出量低状态可能是疾病状态（HIE）和降温治疗共同作用的结果。
