PhD Scientific Days 2020

Clinical Medicine II. Lectures

Comparative Evaluation of Approach to Cardiovascular Care in Asphyxiated Infants with Hemodynamic Instability between a Large Canadian vs Hungarian Referral Center

Előadó neve

Dr. Kovacs, Kata

Előadó munkahelye

1st Department of Paediatrics, Semmelweis University, Budapest, Hungary

Előadó telefonszáma

+36204969653

Előadó e-mail címe

mail.kata.kovacs@gmail.com

Az előadás címe

Comparative Evaluation of Approach to Cardiovascular Care in Asphyxiated Infants with Hemodynamic Instability between a Large Canadian vs Hungarian Referral Center

Szerző(k) neve és munkahelye

Kata Kovacs1, Regan Giesinger2, Andrea Lakatos3, Miklos Szabo1, Patrick J McNamara2,4, Agnes Jermendy1
1 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
2 University of Iowa Health Care, Iowa, USA
3 MR Research Center, Semmelweis University, Budapest, Hungary
4 Hospital for Sick Children, Toronto, Canada

Szekció

Clinical Medicine II. Lectures

Language of the presentation

Hungarian

Section, first choice

Clinical Medicine

Section, second choice

Neurosciences

Összefoglaló szövege

Introduction: Patients with hypoxic-ischemic encephalopathy (HIE) may present with hemodynamic instability. Therapeutic hypothermia (TH) improves neurodevelopmental outcome in asphyxiated newborns, but may worsen hemodynamic instability.
Aims: Our primary aim was to compare the approach to management of hemodynamic instability and short term outcomes in asphyxiated infants at two high volume centers.
Method: In this retrospective cohort study, we studied 176 term infants with HIE, who were admitted to the NICU of the Hospital for Sick Children, Toronto, Canada (Center A, n=86) or the 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary (Center B, n=90) for TH between 2015 and 2017, and developed systemic hypotension (mean arterial pressure less than gestational age). Baseline neonatal demographics, indices of hemodynamic stability and details of hemodynamic interventions were compared. Short term outcome was evaluated based on MRI examinations. Adverse outcome was defined as perinatal death or brain injury in the basal ganglia and/or in the watershed area.
Results: Baseline illness severity and HIE staging were comparable between groups. The average lowest systolic and diastolic blood pressure were similar (44/25 (32) vs 43/24 (31) mmHg). Interestingly 49% of the patients in Center A did not receive any cardiovascular support during TH, whereas only 3% remained untreated in Center B (p<0.001). The first line cardiovascular therapy was dobutamine (66%) in Center A vs dopamine in Center B (94%). The rate of hypertension after the initiation of cardiovascular support was 47% in Center A, while 69% in Center B (p=0.003). Other clinical outcomes (diuresis, convulsions, length of antibiotic treatment and invasive ventilation) were comparable. Adverse outcome was similar in the two centers (49% in Center A and 53% in Center B; p=0.45); however, the pattern of brain injury differed between centers and there was a trend towards increased injury in center A.
Conclusion: A more aggressive approach to cardiovascular care did not lead to better MRI outcomes, but was associated with increased rate of hypertension. Use of early comprehensive echocardiography may provide enhanced diagnostic precision enabling investigation of the relationship of heart function and systemic hemodynamics to brain injury.

Additional Information

SUPPORTED BY THE ÚNKP-19-3-III NEW NATIONAL EXCELLENCE PROGRAM OF THE MINISTRY OF HUMAN CAPACITIES.

Bemutatás módja

Szóbeli

Kind

Szabad

Status

elfogadva

Accepted presentation method

szóbeli

Előadás fájl jóváhagyás

nem rendelkezett róla

Előadó

1249

Start

12:35

End

12:50

Authors (legacy)

Kata Kovacs1, Regan Giesinger2, Andrea Lakatos3, Miklos Szabo1, Patrick J McNamara2,4, Agnes Jermendy1
1 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
2 University of Iowa Health Care, Iowa, USA
3 MR Research Center, Semmelweis University, Budapest, Hungary
4 Hospital for Sick Children, Toronto, Canada