268 - The Impact of Universal Targeted Neonatal Echocardiography Screening on Hemodynamic Stability Among Neonates Undergoing Therapeutic Hypothermia

Publication Number: 4264.268

Ashley Schlapper-Sevcik, University of Iowa Stead Family Children's Hospital, Coralville, IA, United States; Adrianne R. Bischoff, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States; Patrick McNamara, University of Iowa, Iowa city, IA, United States; Stephanie S. Lee, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States; Luisa Correia. Martins, Division of Neonatology, Department of Pediatrics, Unidade Local de Saúde de São José, NOVA Medical School -NOVA University, Lisbon, Portugal, Lisbon, Lisboa, Portugal

Background: Impaired RV performance, in the setting of hypoxic ischemic encephalopathy (HIE) is associated with death and adverse neurodevelopmental outcomes. The impact of early detection of RV dysfunction and targeted neonatal echocardiography (TNE) on clinical outcomes is unknown. At our institution, universal hemodynamic screening (HS), including mandatory TNE in the first 24 hours after birth for all infants undergoing therapeutic hypothermia, was implemented in June 2019.

Objective: The objective of this study is to determine the effects of early cardiovascular derangement detection and treatment on clinical outcomes of patients with hypoxic ischemic encephalopathy undergoing therapeutic hypothermia.

Design/Methods: A retrospective cohort study (July 2013-April 2024) of infants with moderate-severe HIE undergoing therapeutic hypothermia at University of Iowa Stead Family Children’s Hospital was conducted. Patients were analyzed based on 2 epochs: pre-HS (July 2013-June 2019) and post-HS (June 2019-April 2024). Baseline demographics, clinical characteristics and short-term neurological and cardiovascular outcomes were assessed. Standard univariate analyses were performed to compare both epochs.

Results: The post-HS epoch was characterized by lower gestational age, less need for chest compressions, lower duration of bag/mask ventilation and lower rate of clinical seizures (Table 1). Pulmonary hypertension and right ventricular dysfunction were more commonly diagnosed in the post-HS epoch (Table 2). Overall use of cardiovascular medications was similar, but the pre-HS epoch had a higher rate of vasopressors (e.g., dopamine) while the post-HS epoch had a higher use of inotropes (e.g., dobutamine and epinephrine) (Table 2). Despite similar rates of abnormal video EEG background pattern in both epochs, the post-HS epoch had less severe background patterns with higher rates of excessive discontinuity and lower rates of burst suppression, continuous low voltage, or flat tracing (Table 3). Presence of sleep wake cycling was also increased in the post-HS epoch (Table 3).

Conclusion(s): Hemodynamic screening was associated with higher recognition of pulmonary hypertension and right ventricular dysfunction. There was a transition from a dopamine-predominant approach to inotrope-predominant use in the post-HS era. Despite these findings, video EEG background patterns were found to be less severe in the post-HS era, however the long-term impacts of this change warrants further investigation.

Table 1: Demographics and Baseline Characteristics
Table 1 Demographics and Baseline Characteristics.pdfLegend: HS: Hemodynamic screening, CS: Cesarean Section, PPV: positive pressure ventitilation, CPAP: Continuous positive airway pressure, CPR: cardiopulmonary resuscitation, ECMO: Extracorporeal membrane oxygenation, LOS: length of stay, HIE: Hypoxic ischemic encephalopathy. Results are presented as frequencies (%), mean±SD and median [IQR].

Table 2: Cardiovascular Outcomes and Medications
Table 2 Cardiovascular Outcomes and Medications.pdfLegend: HS: hemodynamic screening, TnECHO: Targeted Neonatal Echocardiogram, LV: Left Ventricle, RV: Right Ventricle, PDA: Patent Ductus Arteriosus, PH: Pulmonary Hypertension. Results are presented as frequencies (%), mean±SD and median [IQR], HS: hemodynamic screening, CV: Cardiovascular, iNO: Inhaled Nitric Oxide, PGE: prostaglandin. Results are presented as frequencies (%), mean±SD and median [IQR].

Table 3: Neurological Outcomes
Table 3 Neurological Outcomes.pdfLegend: vEEG: video EEG, MRI: magnetic resonance imaging, MRS: magnetic resonance spectroscopy, NAA: N-acetylaspartate. Results are presented as frequencies (%), mean±SD and median [IQR].