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Am J Perinatol 2018; 35(01): 031-038
DOI: 10.1055/s-0037-1604392
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Hypotension and Brain Injury in Asphyxiated Newborns Treated with Hypothermia

Asim Al Balushi
1   Department of Pediatrics, McGill University, Montreal Children's Hospital, Montreal, Canada
,
Stephanie Barbosa Vargas
1   Department of Pediatrics, McGill University, Montreal Children's Hospital, Montreal, Canada
,
Julie Maluorni
1   Department of Pediatrics, McGill University, Montreal Children's Hospital, Montreal, Canada
,
Priscille-Nice Sanon
1   Department of Pediatrics, McGill University, Montreal Children's Hospital, Montreal, Canada
,
Emmanouil Rampakakis
2   JSS Medical Research, Montreal, Québec, Canada
,
Christine Saint-Martin
3   Department of Pediatric Radiology, McGill University, Montreal Children's Hospital, Montreal, Canada
,
Pia Wintermark
1   Department of Pediatrics, McGill University, Montreal Children's Hospital, Montreal, Canada
› Author Affiliations
Further Information

Publication History

22 March 2017

21 June 2017

Publication Date:
31 July 2017 (online)

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Abstract

Objective This study aimed to assess the incidence of hypotension in asphyxiated newborns treated with hypothermia, the variability in treatments for hypotension, and the impact of hypotension on the pattern of brain injury.

Study Design We conducted a retrospective cohort study of asphyxiated newborns treated with hypothermia. Mean blood pressures, lactate levels, and inotropic support medications were recorded during the hospitalization. Presence and severity of brain injury were scored using the brain magnetic resonance imaging (MRI) obtained after the hypothermia treatment was completed.

Results One hundred and ninety term asphyxiated newborns were treated with hypothermia. Eighty-one percent developed hypotension. Fifty-five percent of the newborns in the hypotensive group developed brain injury compared with 35% of the newborns in the normotensive group (p = 0.04). Twenty-nine percent of the newborns in the hypotensive group developed severe brain injury, compared with only 15% in the normotensive group. Nineteen percent of the newborns presenting with volume- and/or catecholamine-resistant hypotension had near-total injury, compared with 6% in the normotensive group and 8% in the group responding to volume and/or catecholamines.

Conclusion Hypotension was common in asphyxiated newborns treated with hypothermia and was associated with an increased risk of (severe) brain injury in these newborns.

Keywords

birth asphyxia - brain - neonatal encephalopathy - hypotension - inotrope score - newborn

Note

All the authors have contributed to, seen, and approved this article. All the authors fulfill the authorship credit requirements.


Funding

None.


 

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