Electrocardiographic and echocardiographic changes during therapeutic hypothermia in encephalopathic infants with long-term adverse outcome

Montaldo, Paolo; Cuccaro, Pasquale; Caredda, Elisabetta; Pugliese, Umberto; Vivo, Massimiliano De; Orbinato, Francesco; Magri, Daniela; Rojo, Silvana; Rosso, Roberto; Santantonio, Alfredo; Vitiello, Renato; Vacchiano, Teresa; Chello, Giovanni; Giudice, Emanuele Miraglia del; Giliberti, Paolo

doi:10.1016/j.resuscitation.2018.07.014

Cited by 15 publications

(12 citation statements)

References 20 publications

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“…This pattern shows a significantly prolonged QTc interval during therapeutic hypothermia, with subsequent trend to normalization immediately afterwards. This pattern, based on individual measurements, was reported by six different groups and confirms the Montaldo cohort pattern that was based on rich sampling in a single cohort in one intensive care unit [ 22 ]. When quantified by incremental changes in temperature (/°C), this increase in QTc is ‘°C dependent’.…”

Section: Discussionsupporting

confidence: 85%

“…A publication bias due to ‘positive’ cases should also be considered. However, the pattern observed in the pooled individual cases was also observed in median trends and patterns in the reports of cohorts [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ].…”

Section: Discussionsupporting

confidence: 56%

“…For each increment of 1 °C during rewarming, there was an increase of 9.2 bpm, and a QTc interval decrease by 21.6 ms/°C [ 21 ]. Finally, Montaldo et al associated a longer QTc and lower heart rate during therapeutic hypothermia with better neurodevelopmental outcome at 18–24 months [ 22 ]. Using a paired data analysis, QTc intervals were measured on admission, during hypothermia (12, 24, 36, 48, 60, and 72 h) and subsequently during normothermia.…”

Section: Resultsmentioning

confidence: 99%

“…Using a paired data analysis, QTc intervals were measured on admission, during hypothermia (12, 24, 36, 48, 60, and 72 h) and subsequently during normothermia. The authors described a progressive increase in QTc intervals up to 36–48 h, with a subsequent decrease beginning during therapeutic hypothermia which normalized after rewarming [ 22 ].…”

Section: Resultsmentioning

confidence: 99%

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QTc Intervals Are Prolonged in Late Preterm and Term Neonates during Therapeutic Hypothermia but Normalize Afterwards

et al. 2021

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Background: There are anecdotal reports on reversible QTc prolongation during therapeutic hypothermia (TH) for moderate to severe neonatal encephalopathy after asphyxia. As the QTc interval is a relevant biomarker for pharmacovigilance during medication development, a structured search and review on published neonatal QTc values to generate reference values is warranted to facilate medication development in this specific population. Methods: A structured search and literature assessment (PubMed, Embase, and Google Scholar) with ‘Newborn/Infant, QT and hypothermia’ was conducted (October 2021). Retrieved individual values were converted to QTc (Bazett) over postnatal age (day 1–7). Results: We retrieved 94 QTc intervals (during TH (n = 50, until day 3) or subsequent normothermia (n = 44, day 4–7)) in 33 neonates from 6 publications. The median (range) of QTc intervals during TH was 508 (430–678), and 410 (317–540) ms afterwards (difference 98 ms, or +28 ms/°C decrease). Four additional cohorts (without individual QTc intervals) confirmed the pattern and magnitude of the effect of body temperature on the QTc interval. Conclusions: We highlighted a relevant non-maturational covariate (°C dependent TH) and generated reference values for the QTc interval in this specific neonatal subpopulation. This knowledge on QTc during TH should be considered and integrated in neonatal medication development.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 56%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

QTc Intervals Are Prolonged in Late Preterm and Term Neonates during Therapeutic Hypothermia but Normalize Afterwards

et al. 2021

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“…However, studies evaluating the prognostic value of lower HR or low CO are controversial. As TH reduces tissue oxygen demand, high CO is potentially associated with reperfusion injury [22], and low HR seems to be an appropriate response to decreased oxygen demand [23]. Clinical features of shock, such as skin color, capillary refill time, or urine output, may be difficult to appreciate during hypothermia treatment [16].…”

Section: Permissive Hypotensionmentioning

confidence: 99%

Management of Neonatal Hypotension and Shock

Schwarz

Dempsey

2020

Seminars in Fetal and Neonatal Medicine

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The current standard approach to manage circulatory insufficiency is inappropriately simple and clear: respond to low blood pressure to achieve higher values. However, the evidence for this is limited affecting all steps within the process: assessment, decision making, therapeutic options, and treatment effects. We have to overcome the 'one size fits all' approach and respect the dynamic physiologic transition from fetal to neonatal life in the context of complex underlying conditions. Caregivers need to individualize their approaches to individual circumstances. This paper will review various clinical scenarios, including managing transitional low blood pressure, to circulatory impairment involving different pathologies such as hypoxia-ischemia and sepsis. We will highlight the current evidence and set potential goals for future development in these areas. We hope to encourage caregivers to question the current standards and to support urgently needed research in this overlooked but crucial field of neonatal intensive care.

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Therapeutic Approaches for the Treatment of Cerebral Palsy and Developmental Disability

Fehlings

Beldick

Mailo

et al. 2023

Neurodevelopmental Pediatrics

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Electrocardiographic and echocardiographic changes during therapeutic hypothermia in encephalopathic infants with long-term adverse outcome

Cited by 15 publications

References 20 publications

QTc Intervals Are Prolonged in Late Preterm and Term Neonates during Therapeutic Hypothermia but Normalize Afterwards

QTc Intervals Are Prolonged in Late Preterm and Term Neonates during Therapeutic Hypothermia but Normalize Afterwards

Management of Neonatal Hypotension and Shock

Therapeutic Approaches for the Treatment of Cerebral Palsy and Developmental Disability

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