Evaluation of left ventricular function using various echocardiographic techniques in hypoxic neonates during therapeutic hypothermia and after rewarming

Brunets, Natalia; Brunets, Veronika; Wójcik-Sęp, Agata; Bokiniec, Renata

doi:10.15557/jou.2025.0033

Abstract

Aim

The aim of this study was to evaluate left ventricular function in hypoxic neonates undergoing therapeutic hypothermia using echocardiography.

Materials and methods

This multicenter, prospective, case-control, observational study involved 113 neonates, including 55 in the hypothermic group and 58 nonhypothermic controls. Echocardiographic measurements were taken by two neonatologist (NB and RB) during therapeutic hypothermia and after rewarming using various techniques.

Results

There was a significant difference between the study group and controls in mean blood pressure (p <0.001) and heart rate (p = 0.004) during therapeutic hypothermia. Significantly higher post-rewarming heart rate was observed in the study group compared to controls (p <0.001). Significantly lower mean A-wave (A mv) (p = 0.04) and E-wave (E mv) (p = 0.003) mitral valve velocities, as well as reduced mitral annular plane systolic excursion (p <0.001), cardiac output (p <0.001), and left ventricular internal diameter in diastole (p <0.001) were observed in the study group compared to controls during therapeutic hypothermia. The mean left ventricular myocardial performance index was significantly higher in the study group (p = 0.006). Tissue Doppler imaging showed significantly lower left ventricular E’ velocity (p <0.001) and E’/A’ ratio during therapeutic hypothermia in the study group compared to controls. Left ventricular A’ (p = 0.006), E’ (p <0.001), and S’ (p = 0.003) velocities were significantly lower, while myocardial performance index (p <0.001) was significantly higher in the study group during therapeutic hypothermia than after rewarming.

Conclusions

Hypothermic neonates exhibit more severe global impairment compared to healthy controls. This is reflected in higher myocardial performance index values and lower E’/A’ ratio, which indicates diastolic dysfunction.

References

Lapointe A, Barrington KJ: Pulmonary hypertension and the asphyxiated newborn. J Pediatr 2011; 158(2 Suppl): e19–24. doi: 10.1016/j.jpeds.2010.11.008.
Open DOI Search in Google Scholar Back to article
Nestaas E, Walsh BH: Hypothermia and cardiovascular instability. Clin Perinatol 2020; 47: 575–592. doi: 10.1016/j.clp.2020.05.012.
Open DOI Search in Google Scholar Back to article
Pang R, Mintoft A, Crowley R, Sellwood M, Mitra S, Robertson NJ: Optimizing hemodynamic care in neonatal encephalopathy. Semin Fetal Neonatal Med 2020; 25: 101139. doi: 10.1016/j.siny.2020.101139.
Open DOI Search in Google Scholar Back to article
Breatnach CR, Forman E, Foran A, Monteith C, McSweeney L, Malone F et al.: Left ventricular rotational mechanics in infants with hypoxic ischemic encephalopathy and preterm infants at 36 weeks postmenstrual age: a comparison with healthy term controls. Echocardiography 2017; 34: 232–239. doi: 10.1111/echo.13421.
Open DOI Search in Google Scholar Back to article
Gebauer CM, Knuepfer M, Robel-Tillig E, Pulzer F, Vogtmann C: Hemodynamics among neonates with hypoxic-ischemic encephalopathy during whole-body hypothermia and passive rewarming. Pediatrics 2006; 117: 843–850. doi: 10.1542/peds.2004-1587.
Open DOI Search in Google Scholar Back to article
Bokiniec R, Własienko P, Borszewska-Kornacka MK, Madajczak D, Szymkiewicz-Dangel J: Myocardial performance index (Tei index) in term and preterm neonates during the neonatal period. Kardiol Pol 2016; 74: 1002–1009. doi: 10.5603/KP.a2016.0056
Open DOI Search in Google Scholar Back to article
Wu TW, Tamrazi B, Soleymani S, Seri I, Noori S: Hemodynamic changes during rewarming phase of whole-body hypothermia therapy in neonates with hypoxic-ischemic encephalopathy. J Pediatr 2018; 197: 68–74.e2. doi: 10.1016/j.jpeds.2018.01.067
Open DOI Search in Google Scholar Back to article
Kluckow M: Functional echocardiography in assessment of the cardiovascular system in asphyxiated neonates. J Pediatr 2011; 158 (2 Suppl): e13–8. doi: 10.1016/j.jpeds.2010.11.007
Open DOI Search in Google Scholar Back to article
Giesinger RE, Bailey LJ, Deshpande P, McNamara PJ: Hypoxic-ischemic encephalopathy and therapeutic hypothermia: the hemodynamic perspective. J Pediatr 2017; 180: 22–30.e2. doi: 10.1016/j.jpeds.2016.09.009
Open DOI Search in Google Scholar Back to article
Standardy opieki medycznej nad noworodkiem w Polsce 2021. Zalecenia Polskiego Towarzystwa Neonatologicznego. Media-Press 2021.
Search in Google Scholar Back to article
Thoresen M, Whitelaw A: Cardiovascular changes during mild therapeutic hypothermia and rewarming in infants with hypoxic-ischemic encephalopathy. Pediatrics 2000; 106: 92–99. doi: 10.1542/peds.106.1.92
Open DOI Search in Google Scholar Back to article
Thomsen JH, Hassager C, Bro-Jeppesen J, Søholm H, Nielsen N, Wanscher M et al.: Sinus bradycardia during hypothermia in comatose survivors of out- of-hospital cardiac arrest – a new early marker of favorable outcome? Resuscitation 2015; 89: 36–42. doi: 10.1016/j.resuscitation.2014.12.031
Open DOI Search in Google Scholar Back to article
Drury PP, Gunn ER, Bennet L, Gunn AJ: Mechanisms of hypothermic neuroprotection. Clin Perinatol 2014; 41: 161–175. doi: 10.1016/j.clp.2013.10.005
Open DOI Search in Google Scholar Back to article
Sobeih AA, El-Baz MS, El-Shemy DM, Abu El-Hamed WA: Tissue Doppler imaging versus conventional echocardiography in assessment of cardiac diastolic function in full term neonates with 566 perinatal asphyxia. J Matern Fetal Neonatal Med 2021; 34: 3896–3901. doi: 10.1080/14767058.2019.1702640
Open DOI Search in Google Scholar Back to article
Matter M, Abdel-Hady H, Attia G, Hafez M, Seliem W, Al-Arman M: Myocardial performance in asphyxiated full-term infants assessed by Doppler tissue imaging. Pediatr Cardiol 2010; 31: 634–642. doi: 10.1007/s00246-010-9661-5
Open DOI Search in Google Scholar Back to article
Hochwald O, Jabr M, Osiovich H, Miller SP, McNamara PJ, Lavoie PM: Preferential cephalic redistribution of left ventricular cardiac output during therapeutic hypothermia for perinatal hypoxic-ischemic encephalopathy. J Pediatr 2014; 164: 999–1004.e1. doi: 10.1016/j.jpeds.2014.01.028
Open DOI Search in Google Scholar Back to article
Jiang K, Li Y, Xu X, Sun C: Application of the Tei index in neonates with perinatal asphyxia. Int J Clin Exp Med 2016; 9: 13111–13116.
Search in Google Scholar Back to article
Karpuz D, Celik Y, Giray D, Tasdelen B, Hallioglu O: Therapeutic hypothermia and myocardium in perinatal asphyxia: a microvolt T-wave alternans and Doppler echocardiography study. Bratisl Lek Listy 2017; 118: 765–771. doi: 10.4149/BLL_2017_144
Open DOI Search in Google Scholar Back to article
Kanik E, Ozer EA, Bakiler AR, Aydinlioglu H, Dorak C, Dogrusoz B et al.: Assessment of myocardial dysfunction in neonates with hypoxic-ischemic encephalopathy: is it a significant predictor of mortality? J Matern Fetal Neonatal Med 2009; 22: 239–242. doi: 10.1080/14767050802430834
Open DOI Search in Google Scholar Back to article
Montaldo P, Cuccaro P, Caredda E, Pugliese U, De Vivo M, Orbinato F et al.: Electrocardiographic and echocardiographic changes during therapeutic hypothermia in encephalopathic infants with long-term adverse outcome. Resuscitation 2018; 130: 99–104. doi: 10.1016/j.resuscitation.2018.07.014
Open DOI Search in Google Scholar Back to article
Eriksen VR, Trautner S, Hahn GH, Greisen G: Lactate acidosis and cardiac output during initial therapeutic cooling in asphyxiated newborn infants. PLoS One 2019; 14: e0213537. doi: 10.1371/journal.pone.0213537
Open DOI Search in Google Scholar Back to article

Evaluation of left ventricular function using various echocardiographic techniques in hypoxic neonates during therapeutic hypothermia and after rewarming

Abstract

Aim

Materials and methods

Results

Conclusions

Paradigm

My account