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

• Published in: Journal of perinatology Vol. 44; no. 4; pp. 513 - 520
• Main Authors: Kilmartin, Keira C, Al Balushi, Asim, Altit, Gabriel, Lapointe, Anie, Rampakakis, Emmanouil, Barbosa Vargas, Stephanie, Maluorni, Julie, Wintermark, Pia
• Format: Journal Article
• Language: English
• Published: United States Nature Publishing Group 01.04.2024
• Subjects: Blood pressure; Brain; Brain Injuries - complications; Brain injury; Cryotherapy; Encephalopathy; Head injuries; Humans; Hypertension; Hypertension, Pulmonary - complications; Hypertension, Pulmonary - therapy; Hypotension; Hypothermia; Hypothermia, Induced - adverse effects; Infant, Newborn; Infant, Newborn, Diseases - therapy; Lungs; Neonates; Neurological disorders; Newborn babies; Oxygen; Oxygen - therapeutic use; Oxygenation; Partial pressure; Persistent Fetal Circulation Syndrome - drug therapy; Persistent Fetal Circulation Syndrome - therapy; Traumatic brain injury
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/s41372-023-01805-2

To investigate the effects of persistent pulmonary hypertension (PPHN) and oxygenation on outcome of neonates with neonatal encephalopathy (NE) treated with therapeutic hypothermia (TH). We compared the outcome of neonates with NE treated with TH with or without PPHN. 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). PPHN occurred frequently in neonates with NE treated with TH and was associated with a higher incidence of adverse outcome.