Sanjeev Aggarwal1, Prashant Agarwal1, Girija Natarajan2. 1. Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA. 2. Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA. gnatara@med.wayne.edu.
Abstract
OBJECTIVE: Among neonates undergoing whole body cooling for hypoxic-ischemic encephalopathy (HIE), to compare ventricular function in the presence and absence of pulmonary hypertension (PPHN) needing inhaled nitric oxide (iNO)/ECMO. DESIGN: This retrospective study included infants with HIE who underwent cooling. ECHO (<24 h age) measures, RV fractional area change (FAC), RV Tricuspid annular plane systolic excursion (TAPSE), myocardial performance indices (MPI), and the RV systolic to diastolic duration (S/D) ratio were evaluated. RESULTS: The iNO/ECMO group (n = 26) had lower TAPSE and RV FAC and higher RV MPI and S/D, compared with controls (n = 39). Area under the curve was highest for RV S/D, with fair sensitivity (95% CI) [76.9 (56.3-91%)] and negative predictive value [78.6 (63.3-88.6%)] for subsequent iNO/ECMO at cutoff >1.45. CONCLUSIONS: Infants with HIE undergoing cooling who progressed to iNO/ECMO for PPHN had RV dysfunction on early ECHO; S/D had the best predictive performance. RV S/D may be a useful early marker of PPHN in HIE.
OBJECTIVE: Among neonates undergoing whole body cooling for hypoxic-ischemicencephalopathy (HIE), to compare ventricular function in the presence and absence of pulmonary hypertension (PPHN) needing inhaled nitric oxide (iNO)/ECMO. DESIGN: This retrospective study included infants with HIE who underwent cooling. ECHO (<24 h age) measures, RV fractional area change (FAC), RV Tricuspid annular plane systolic excursion (TAPSE), myocardial performance indices (MPI), and the RV systolic to diastolic duration (S/D) ratio were evaluated. RESULTS: The iNO/ECMO group (n = 26) had lower TAPSE and RV FAC and higher RV MPI and S/D, compared with controls (n = 39). Area under the curve was highest for RV S/D, with fair sensitivity (95% CI) [76.9 (56.3-91%)] and negative predictive value [78.6 (63.3-88.6%)] for subsequent iNO/ECMO at cutoff >1.45. CONCLUSIONS:Infants with HIE undergoing cooling who progressed to iNO/ECMO for PPHN had RV dysfunction on early ECHO; S/D had the best predictive performance. RV S/D may be a useful early marker of PPHN in HIE.