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Respiratory and Hemodynamic Changes in Neonates with Hypoxic–Ischemic Encephalopathy during and after Whole-Body Hypothermia
Objective This study aimed to determine the degree to which whole-body hypothermia (WBH) impacts hemodynamic and respiratory status during hypothermia and the subsequent rewarming period in neonates with hypoxic–ischemic encephalopathy (HIE).
Study Design This is a retrospective study reviewing the medical records of infants treated with WBH. Data including oxygenation index (OI), ventilator efficiency index (VEI), fraction of inspired oxygen (FiO2), blood lactate level, heart rate (HR), and mean blood pressure (MBP) were collected from defined time points from the beginning, middle, and end of WBH and then every 2 hours from the beginning of rewarming for 14 hours thereafter. The analysis included 65 infants. Data were analyzed using a piecewise linear regression with a mixed-effect model.
Results HR decreased during WBH and significantly increased during rewarming. Lactate level, OI, VEI, FiO2, and MBP all decreased during WBH but showed no significant change during and after rewarming.
Conclusion There was a decrease in metabolic demand as measured by oxygen requirement, OI, HR, and MBP during WBH, but only HR increased during rewarming, with no significant change in the other parameters. Some of this effect may be explained by improvement in the respiratory condition over time.
Received: 29 January 2019
Accepted: 28 June 2019
14 August 2019 (online)
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- 1 Shankaran S, Laptook AR, Ehrenkranz RA. et al; National Institute of Child Health and Human Development Neonatal Research Network. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med 2005; 353 (15) 1574-1584
- 2 Azzopardi D, Strohm B, Marlow N. et al; TOBY Study Group. Effects of hypothermia for perinatal asphyxia on childhood outcomes. N Engl J Med 2014; 371 (02) 140-149
- 3 Chiara O, Giomarelli PP, Biagioli B, Rosi R, Gattinoni L. Hypermetabolic response after hypothermic cardiopulmonary bypass. Crit Care Med 1987; 15 (11) 995-1000
- 4 Puhakka K, Räsänen J, Leijala M, Peltola K. Oxygen consumption following pediatric cardiac surgery. J Cardiothorac Vasc Anesth 1994; 8 (06) 642-648
- 5 Aslami H, Binnekade JM, Horn J, Huissoon S, Juffermans NP. The effect of induced hypothermia on respiratory parameters in mechanically ventilated patients. Resuscitation 2010; 81 (12) 1723-1725
- 6 Dassios T, Austin T. Respiratory function parameters in ventilated newborn infants undergoing whole body hypothermia. Acta Paediatr 2014; 103 (02) 157-161
- 7 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
- 8 Polderman KH. Mechanisms of action, physiological effects, and complications of hypothermia. Crit Care Med 2009; 37 (7, Suppl): S186-S202
- 9 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 (03) 843-850
- 10 Notter RH, Egan EA, Kwong MS, Holm BA, Shapiro DL. Lung surfactant replacement in premature lambs with extracted lipids from bovine lung lavage: effects of dose, dispersion technique, and gestational age. Pediatr Res 1985; 19 (06) 569-577