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Impact of persistent pulmonary hypertension and oxygenation on brain injury in neonates with neonatal encephalopathy treated with therapeutic hypothermia

Journal of Perinatology volume 44, pages 513–520 (2024)Cite this article

Subjects

Abstract

Objective

To investigate the effects of persistent pulmonary hypertension (PPHN) and oxygenation on outcome of neonates with neonatal encephalopathy (NE) treated with therapeutic hypothermia (TH).

Study design

We compared the outcome of neonates with NE treated with TH with or without PPHN.

Results

384 neonates with NE were treated with TH; 24% had PPHN. The fraction of inspired oxygen was higher in the first 4 days of life (p < 0.001) in neonates with PPHN. They had a significantly lower arterial partial pressure of oxygen in the first 4 days of life (p = 0.005) and higher on days 3-4 of life (p < 0.001). They were more often intubated (p < 0.001) and more often had concomitant hypotension (p < 0.001). They had higher mortality (p = 0.009) and more often developed brain injury (p = 0.02).

Conclusion

PPHN occurred frequently in neonates with NE treated with TH and was associated with a higher incidence of adverse outcome.

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Fig. 1: Flow chart of the neonates with NE treated with TH included in the study.
Fig. 2: Maximum fraction of inspired oxygen (FiO2) in neonates with NE treated with TH over the first four days of life, depending on whether they had or did not have PPHN.
Fig. 3: Variations in arterial partial pressure of oxygen (PaO2) in neonates with NE treated with TH over the first four days of life, depending on whether they had or did not have PPHN.
Fig. 4: Association between arterial partial pressure of oxygen (PaO2) in neonates with NE treated with TH over the first four days of life and brain injury.
Fig. 5: Association between vasoactive-inotropic score (VIS) and brain injury in neonates with NE treated with TH.

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Data availability

Data collected for the study cannot be made available for others, since the parents of the enrolled neonates did not give consent to share data with other parties.

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Acknowledgements

We thank Mr. Wayne Ross Egers for his professional English correction of the paper.

Funding

PW holds a William Dawson Scholar Award from the McGill Faculty of Medicine and Health Sciences and receives research grant funding from the FRSQ Clinical Research Scholar Career Award Senior and a CIHR Project Grant.

Author information

Authors and Affiliations

  1. Division of Newborn Medicine, Department of Pediatrics, Montreal Children’s Hospital, McGill University, Montreal, QC, Canada

    Keira C. Kilmartin, Asim Al Balushi, Gabriel Altit, Stephanie Barbosa Vargas, Julie Maluorni & Pia Wintermark

  2. Department of Pediatric Cardiology, National Heart Centre, Muscat, Oman

    Asim Al Balushi

  3. Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada

    Gabriel Altit & Pia Wintermark

  4. Division of Newborn Medicine, Department of Pediatrics, CHU Ste-Justine, University of Montreal, Montreal, QC, Canada

    Anie Lapointe

  5. Medical Affairs, JSS Medical Research, Montreal, QC, Canada

    Emmanouil Rampakakis

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Contributions

KK and AAA collected, analyzed, and interpreted data, and drafted the first versions of the manuscript. GA and AL contributed their expertise in functional echocardiography to the interpretation of the results and revised the manuscript. ER helped with the statistical analysis and revised the manuscript. SBV and JM collected data and revised the manuscript. PW designed the study, supervised the work of KK and AAA for their work, and revised the manuscript. All authors approved the final version of the manuscript and agree to be accountable for all aspects of the work.

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Correspondence to Pia Wintermark.

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Kilmartin, K.C., Al Balushi, A., Altit, G. et al. Impact of persistent pulmonary hypertension and oxygenation on brain injury in neonates with neonatal encephalopathy treated with therapeutic hypothermia. J Perinatol 44, 513–520 (2024). https://doi.org/10.1038/s41372-023-01805-2

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