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Cardiac Function In School Aged Children Cooled For Neonatal Hypoxic Ischaemic Encephalopathy

Jack J. C. Gibb, Richard Lee-Kelland, Beverly Tsai-Goodman, Owen Burgess, Marianne Thoresen, Ela Chakkarapani

Institution(s): Bristol Royal Hospital for Children, University Hospitals Bristol NHS Trust, UK, Translational Health Sciences, Bristol Medical School, University of Bristol, UK, Royal Brompton and Harefield Hospital, Royal Brompton & Harefield NHS Trust, UK, Institute of Physiology, University of Oslo, Norway.

Objective Whether neonates with hypotension or high cardiac troponin I (cTnI) levels during therapeutic hypothermia (TH) for neonatal hypoxic-ischaemic encephalopathy (HIE) have abnormal cardiac function at childhood is unknown. We investigated the cardiac function at childhood for neonates with or without hypotension or high cTnI during TH and examined association between cTnI and cardiac function.

Design Prospective observational study between October 2015 and August 2016.
Setting Bristol Children’s Hospital, UK.
Patients 15 children aged 6-8 years who underwent TH for HIE and were classified based on receiving inotropic support for hypotension and cTnI threshold of 0.087ng/ml within 12 hours of life.
Main outcome measures Echocardiographic left ventricle (LV) and right ventricle (RV) systolic and diastolic function

High cTnI (n=10) compared to low cTnI (n=5) group had significantly lower median (IQR) pH(6.87 (6.80, 6.90) vs 6.97 (6.90, 7.05), P = 0.036) and base excess (-23.0 (-26.4, -19.5) vs -13.4 (-16.2, -12.0), P=0.005) perinatally. Inotrope (n=8) versus non-inotrope (n=7) group, and high versus low cTNI group did not differ in the LV and RV systolic or diastolic measures. LV global longitudinal strain z score was <<-2 in 7%; global circumferential strain z scores were >+2 in 33.3-93% from basal to apical level. Correlations between peak cTnI and cardiac function did not survive multiple testing correction.

Abnormalities in LV function might occur in children who had myocardial injury during cooling for HIE. Longitudinal evaluation of infants with imaging evidence of neonatal cardiac dysfunction are required to identify persisting cardiac abnormalities.

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