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Cerebral blood flow velocity and oxygenation correlate predominantly with right ventricular function in cooled neonates with moderate-severe hypoxic-ischemic encephalopathy

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Abstract

The relationship between right ventricular (RV) function and cerebral blood flow (CBF) velocity and cerebral oxygenation was assessed in neonates with hypoxic-ischemic encephalopathy (HIE) treated with therapeutic hypothermia (TH). Echocardiographic, transcranial Doppler, and hemodynamic data from 37 neonates with moderate-severe HIE + TH were reviewed. Twenty healthy newborns served as controls. Cardiac dysfunction in HIE + TH was characterized by a predominant RV dysfunction, with concomitantly reduced CBF velocity. A significant correlation was found between CBF velocity and tricuspid annular plane systolic excursion (TAPSE), RV output (RVO), and stroke volume (SVRV), as well as with left ventricular output and stroke volume. Brain oxygenation (rSO2) correlated significantly with RVO, SVRV, TAPSE, ejection fraction, and fractional shortening, whereas cerebral fractional tissue oxygen extraction (FTOEc) correlated with RVO, SVRV, RV myocardial performance index, and superior vena cava flow. CBF velocity and cerebral NIRS correlations were stronger with parameters of right ventricular performance.

Conclusion: CBF velocity and brain oxygenation correlate predominantly with RV function in HIE + TH. This suggests a preferential contribution of RV performance to cerebral hemodynamics in this context.

What is Known:

• Neonates with hypoxic ischemic encephalopathy frequently exhibit alterations of cardiac function and cerebral blood flow.

• These are considered organ-specific consequences of perinatal asphyxia.

What is New:

• We show that cerebral blood flow velocity and brain oxygenation are correlated predominantly with right ventricular function during therapeutic hypothermia.

• This suggests a potential direct contribution of right ventricular performance to cerebral hemodynamics in this context.

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Abbreviations

BP:

Blood pressure

CBF:

Cerebral blood flow

cFTOE:

Cerebral fractional tissue oxygen extraction

CO:

Cardiac output

CrSO2:

Cerebral regional oxygen saturation

CTnI:

Cardiac troponin I

EDV:

End diastolic velocity

EF:

Ejection fraction

FS:

Fractional shortening

FTOE:

Fractional tissue oxygen extraction

HIE:

Hypoxic-ischemic encephalopathy

HR:

Heart rate

IQR:

Inter quartile range

LFESD:

Left ventricular end systolic diameters

LV:

Left ventricle

LVEDD:

Left ventricular end diastolic diameter

LVET:

Left ventricular ejection time

LVO:

Left ventricular output

MCA:

Mean cerebral artery

MPI:

Myocardial performance index or Tei index

MPILV :

Left ventricular myocardial performance index or Tei index

MPIRV :

Right ventricular myocardial performance index or Tei index

NICU:

Neonatal intensive care unit

NIRS:

Near-infrared spectroscopy

NPE:

Neonatologist-performed echocardiography

PAAT:

Pulmonary artery accelerating time

PDA:

Patent ductus arteriosus

PFO:

Patent foramen ovale

PH:

Pulmonary hypertension

PSV:

Peak systolic velocity

PVR:

Pulmonary vascular resistance

RI:

Resistive index

rSO2:

Regional oxygen saturation

RV:

Right ventricle

RVET:

Right ventricular ejection time

RVO:

Right ventricular output

SrSO2:

Somatic regional oxygen saturation

SV:

Stroke volume

SVCF:

Superior vena cava flow

SVLV :

Left ventricular stroke volume

SVRV :

Right ventricular stroke volume

TAPSE:

Tricuspid annular plane systolic excursion

TH:

Therapeutic hypothermia

TPV:

Time to peak velocity

VTI:

Velocity time integral

D:

Diameter

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Authors and Affiliations

  1. Division of Neonatology, Insituto del Niño y del Adolescente. Hospital Clinico San Carlos –IdISSC, Prof. Martin Lagos s/n, 28040, Madrid, Spain

    Maria Jose Rodriguez, Araceli Corredera, Jose Martinez-Orgado & Luis Arruza

Authors
  1. Maria Jose Rodriguez
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  2. Araceli Corredera
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  3. Jose Martinez-Orgado
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  4. Luis Arruza
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Contributions

Study design: LA and MJR. Acquisition of data: MJR, AC, and LA. Data analysis: JMO. Interpretation of data: MJR, AC, JMO, and LA. Manuscript drafting: LA. All the authors critically reviewed the draft and gave their approval to the final version of the manuscript.

Corresponding author

Correspondence to Luis Arruza.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the local Ethics Committee.

Informed consent

An exemption of formal consent was obtained for the inclusion of retrospective data. Parental informed consent was obtained before enrollment of control patients.

Additional information

Communicated by Daniele De Luca,

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Rodriguez, M.J., Corredera, A., Martinez-Orgado, J. et al. Cerebral blood flow velocity and oxygenation correlate predominantly with right ventricular function in cooled neonates with moderate-severe hypoxic-ischemic encephalopathy. Eur J Pediatr 179, 1609–1618 (2020). https://doi.org/10.1007/s00431-020-03657-w

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  • DOI: https://doi.org/10.1007/s00431-020-03657-w

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