Gastrointestinal hemodynamic changes during therapeutic hypothermia and after rewarming in neonatal hypoxic-Ischemic encephalopathy
Background: Hypoxic-ischemic encephalopathy (HIE) is associated with disturbances in visceral blood flow velocities. Therapeutic Hypothermia (TH) is a standard of care; however, its impact on gastrointestinal blood flow in infants with HIE is unknown. The objective of this study was to assess gastro...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2019-12-01
|
| Series: | Pediatrics and Neonatology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1875957218305643 |
| _version_ | 1818298841539018752 |
|---|---|
| author | Pankaj Sakhuja Kiran More Joseph Y. Ting Jesal Sheth Annie Lapointe Amish Jain Patrick J. McNamara Aideen M. Moore |
| author_facet | Pankaj Sakhuja Kiran More Joseph Y. Ting Jesal Sheth Annie Lapointe Amish Jain Patrick J. McNamara Aideen M. Moore |
| author_sort | Pankaj Sakhuja |
| collection | DOAJ |
| description | Background: Hypoxic-ischemic encephalopathy (HIE) is associated with disturbances in visceral blood flow velocities. Therapeutic Hypothermia (TH) is a standard of care; however, its impact on gastrointestinal blood flow in infants with HIE is unknown. The objective of this study was to assess gastrointestinal (GI) blood flow and left ventricle output (LVO) in infants with hypoxic-ischemic encephalopathy during whole body TH and after rewarming. Methods: Serial echocardiography and Doppler evaluation of intestinal blood flow (celiac (CA) and superior mesenteric (SMA) arteries) were prospectively performed in a cohort of 20 newborn infants with HIE at 4 time points during hypothermia and after rewarming. Demographic, clinical and biochemical data were collected and analyzed for their relevance. Results: Median gestational age and birth weight was 40 weeks (37–41) and 3410 g (2190–4950) respectively. Celiac and mesenteric artery flow remained low during hypothermia and rose significantly after rewarming [peak systolic velocity in CA (0.63 m/s to 0.77 m/s, p = 0.004) and SMA (0.43 m/s to 0.55 m/s, p = 0.001)]. This increase was temporally associated with increased left ventricular output (106 ml/kg/min to 149 ml/kg/min, p < 0.0001). Median age to reach 25% of the feeds was 5 days (1–7 days). All patients survived. Conclusions: CA and SMA blood flow velocity and LVO did not vary during hypothermia but rose after rewarming. This may suggest protective effect of therapeutic hypothermia on gastrointestinal system. The association of these physiological changes with neonatal outcome needs further assessment. Key Words: celiac artery, hemodynamic changes, superior mesentery artery, therapeutic hypothermia |
| first_indexed | 2024-12-13T04:41:44Z |
| format | Article |
| id | doaj.art-4aabef056e1346a79c1449c3cdcd195b |
| institution | Directory Open Access Journal |
| issn | 1875-9572 |
| language | English |
| last_indexed | 2024-12-13T04:41:44Z |
| publishDate | 2019-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Pediatrics and Neonatology |
| spelling | doaj.art-4aabef056e1346a79c1449c3cdcd195b2022-12-21T23:59:18ZengElsevierPediatrics and Neonatology1875-95722019-12-01606669675Gastrointestinal hemodynamic changes during therapeutic hypothermia and after rewarming in neonatal hypoxic-Ischemic encephalopathyPankaj Sakhuja0Kiran More1Joseph Y. Ting2Jesal Sheth3Annie Lapointe4Amish Jain5Patrick J. McNamara6Aideen M. Moore7Division of Neonatology, The Hospital for Sick Children, Toronto, Canada; Department of Neonatology, London Neonatal Transfer Service, Royal London Hospital, London, UK; Corresponding author. London Neonatal Transfer Service, Department of Neonatology, The Royal London Hospital, Whitechapel Rd, Whitechapel, London, E1 1BB, UK. Fax: +44737456968.Division of Neonatology, The Hospital for Sick Children, Toronto, CanadaDepartment of Pediatrics, University of British Columbia, Vancouver, CanadaFortis Hospital, Mumbai, IndiaSte-Justine Hospital, Montreal, CanadaDivision of Neonatology, Mount Sinai Hospital, University of Toronto, Toronto, Canada; Department of Pediatrics, University of Toronto, Toronto, CanadaDivision of Neonatology, The Hospital for Sick Children, Toronto, Canada; Department of Pediatrics, University of Toronto, Toronto, Canada; Department of Physiology, University of Toronto, Toronto, CanadaDivision of Neonatology, The Hospital for Sick Children, Toronto, Canada; Department of Pediatrics, University of Toronto, Toronto, CanadaBackground: Hypoxic-ischemic encephalopathy (HIE) is associated with disturbances in visceral blood flow velocities. Therapeutic Hypothermia (TH) is a standard of care; however, its impact on gastrointestinal blood flow in infants with HIE is unknown. The objective of this study was to assess gastrointestinal (GI) blood flow and left ventricle output (LVO) in infants with hypoxic-ischemic encephalopathy during whole body TH and after rewarming. Methods: Serial echocardiography and Doppler evaluation of intestinal blood flow (celiac (CA) and superior mesenteric (SMA) arteries) were prospectively performed in a cohort of 20 newborn infants with HIE at 4 time points during hypothermia and after rewarming. Demographic, clinical and biochemical data were collected and analyzed for their relevance. Results: Median gestational age and birth weight was 40 weeks (37–41) and 3410 g (2190–4950) respectively. Celiac and mesenteric artery flow remained low during hypothermia and rose significantly after rewarming [peak systolic velocity in CA (0.63 m/s to 0.77 m/s, p = 0.004) and SMA (0.43 m/s to 0.55 m/s, p = 0.001)]. This increase was temporally associated with increased left ventricular output (106 ml/kg/min to 149 ml/kg/min, p < 0.0001). Median age to reach 25% of the feeds was 5 days (1–7 days). All patients survived. Conclusions: CA and SMA blood flow velocity and LVO did not vary during hypothermia but rose after rewarming. This may suggest protective effect of therapeutic hypothermia on gastrointestinal system. The association of these physiological changes with neonatal outcome needs further assessment. Key Words: celiac artery, hemodynamic changes, superior mesentery artery, therapeutic hypothermiahttp://www.sciencedirect.com/science/article/pii/S1875957218305643 |
| spellingShingle | Pankaj Sakhuja Kiran More Joseph Y. Ting Jesal Sheth Annie Lapointe Amish Jain Patrick J. McNamara Aideen M. Moore Gastrointestinal hemodynamic changes during therapeutic hypothermia and after rewarming in neonatal hypoxic-Ischemic encephalopathy Pediatrics and Neonatology |
| title | Gastrointestinal hemodynamic changes during therapeutic hypothermia and after rewarming in neonatal hypoxic-Ischemic encephalopathy |
| title_full | Gastrointestinal hemodynamic changes during therapeutic hypothermia and after rewarming in neonatal hypoxic-Ischemic encephalopathy |
| title_fullStr | Gastrointestinal hemodynamic changes during therapeutic hypothermia and after rewarming in neonatal hypoxic-Ischemic encephalopathy |
| title_full_unstemmed | Gastrointestinal hemodynamic changes during therapeutic hypothermia and after rewarming in neonatal hypoxic-Ischemic encephalopathy |
| title_short | Gastrointestinal hemodynamic changes during therapeutic hypothermia and after rewarming in neonatal hypoxic-Ischemic encephalopathy |
| title_sort | gastrointestinal hemodynamic changes during therapeutic hypothermia and after rewarming in neonatal hypoxic ischemic encephalopathy |
| url | http://www.sciencedirect.com/science/article/pii/S1875957218305643 |
| work_keys_str_mv | AT pankajsakhuja gastrointestinalhemodynamicchangesduringtherapeutichypothermiaandafterrewarminginneonatalhypoxicischemicencephalopathy AT kiranmore gastrointestinalhemodynamicchangesduringtherapeutichypothermiaandafterrewarminginneonatalhypoxicischemicencephalopathy AT josephyting gastrointestinalhemodynamicchangesduringtherapeutichypothermiaandafterrewarminginneonatalhypoxicischemicencephalopathy AT jesalsheth gastrointestinalhemodynamicchangesduringtherapeutichypothermiaandafterrewarminginneonatalhypoxicischemicencephalopathy AT annielapointe gastrointestinalhemodynamicchangesduringtherapeutichypothermiaandafterrewarminginneonatalhypoxicischemicencephalopathy AT amishjain gastrointestinalhemodynamicchangesduringtherapeutichypothermiaandafterrewarminginneonatalhypoxicischemicencephalopathy AT patrickjmcnamara gastrointestinalhemodynamicchangesduringtherapeutichypothermiaandafterrewarminginneonatalhypoxicischemicencephalopathy AT aideenmmoore gastrointestinalhemodynamicchangesduringtherapeutichypothermiaandafterrewarminginneonatalhypoxicischemicencephalopathy |