Affiliations: [a] Department of Pediatrics, Section of Neonatology, Cumming School of Medicine, Calgary, Canada
| [b] Department of Pediatrics, Section of Pediatric Cardiology, Cumming School of Medicine, Calgary, Canada
| [c] Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Canada
| [d] Departments of Diagnostic Imaging and Clinical Neurosciences, University of Calgary, Calgary, Canada
| [e] Libin Cardiovascular Institute of Alberta, Calgary, Canada
Correspondence:
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Address for correspondence: Amelie Stritzke, MD, FRCPC, Associate Professor of Pediatrics, University of Calgary, Foothills Medical Centre, 780A, 1403, 29th Street NW, Calgary, Alberta T2N 2T9. Tel.: +403 943 8580; Fax: +403 944 1672; E-mail: Amelie.Stritzke@albertahealthservices.ca.
Abstract: BACKGROUND:Our aim was to investigate the relationship between persistent pulmonary hypertension of the newborn (PPHN), short-term brain injury or death, and clinical parameters in infants with moderate to severe hypoxic ischemic encephalopathy (HIE). METHODS:Retrospective single-center cohort study of 274 HIE infants, 230 underwent Therapeutic Hypothermia (TH). Primary outcome was severe HIE brain injury on MRI and/or death within the first month of life in relation to presence and severity of PPHN (clinical or echocardiographic). Secondary outcomes were HIE brain injury pattern, abnormal electroencephalogram (EEG), seizures, clinical, and laboratory differences. A logistic regression model was performed to evaluate PPHN presence and severity as risk factor for brain injury or death. RESULTS:The combined outcome of severe brain injury or death was higher in the clinical PPHN group vs non-PPHN (32.6 vs 22.8%, p = 0.014). There was no difference in brain injury, seizure burden or EEG abnormalities associated with PPHN, despite those with PPHN being sicker with higher ventilation needs and worse laboratory values than those without. Mortality had a strong correlation with echocardiographic PPHN with the highest incidence in severe (36%) vs moderate (7.7%) vs mild PPHN (10%, p = 0.002). Highest mortality had those with ‘early exit’ who did not complete 72 hours of TH (71.4%). CONCLUSIONS:In infants with HIE, PPHN was not associated with increased risk of brain injury as evident on MRI, nor seizure burden, despite being sicker with worse laboratory values. However, mortality rates were higher the worse the PPHN, especially with early exit from TH.
Keywords: Parkinson’s disease, deep brain stimulation, pregnancy
