Association between cardiovascular care and neurodevelopmental outcomes in infants with neonatal encephalopathy and hemodynamic instability

Objective: To analyze the approach to cardiovascular care and long-term outcomes in infants undergoing hypothermia for neonatal encephalopathy (NE). Study design: This is a retrospective cohort study of 152 infants with NE [SickKids Hospital (Center A, n = 74) or Semmelweis University (Center B, n = 78)], who developed hypotension and underwent neonatal follow-up. Primary outcome was defined as death or neurodevelopmental impairment (<70 on Bayley-II or <85 points on Bayley-III test). Result: The presence of hypoxic injury in the brain MRI increased the odds of adverse outcome by 10.5 fold. In addition, for every 24 h increase in the duration of cardiovascular support the odds of adverse outcome increased by 12%. In a subgroup of patients with detailed echocardiography evaluation lower tricuspid annulus plane systolic excursion was noted in the non-survivors. Conclusion: Hypoxic brain injury and longer cardiovascular therapy are independently associated with the adverse long-term outcome in patients with NE.