177 - Therapeutic hypothermia by esophageal versus rectal site in infants with hypoxic-ischemic encephalopathy

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 177
Publication Number: 177.137

Tai-Wei Wu, Division of Neonatology, Fetal and Neonatal Institute, Children’s Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine of USC, Los Angeles, California, United States, Los Angeles, CA, United States; Robert Schmick, University of Washington, Seattle, WA, United States; Bryan Comstock, University of Washington School of Medicine, Seattle, WA, United States; Thomas R. Wood, University of Washington School of Medicine, Seattle, WA, United States; Ulrike Mietzsch, University of Washington School of Medicine, Seattle, WA, United States; Patrick Heagerty, University of Washington, seattle, WA, United States; Sandra Juul, Sandra Juul, Bellevue, WA, United States; Yvonne Wu, UCSF, San Francisco, CA, United States

Presenting Author(s)

Tai-Wei Wu, MD (he/him/his)

Associate Professor of Pediatrics
Division of Neonatology, Fetal and Neonatal Institute, Children’s Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine of USC, Los Angeles, California, United States
Los Angeles, California, United States

Background: The esophagus and rectum are accepted sites for core temperature monitoring during therapeutic hypothermia (TH) for hypoxic-ischemic encephalopathy (HIE). During TH, esophageal temperature is higher than rectal temperature by 0.5-1.0°C. Therefore, the site at which core temperature is monitored can lead to differences in the depth of hypothermia. It is unknown if TH by esophageal or rectal monitoring affects outcomes.

Objective:

To compare the short-term effects and neurodevelopmental outcomes of infants undergoing TH monitored by esophageal versus rectal temperature.

Design/Methods: This is a secondary analysis of the multi-center trial of High-Dose Erythropoietin for Asphyxia and encephaLopathy (HEAL). All infants had moderate or severe HIE and were treated with TH. The primary outcome was death or neurodevelopmental impairment (NDI), defined as cerebral palsy, gross motor function classification system level of ≥1, or cognitive score < 90 on the Bayley III, at 22-36 months of age. Secondary outcomes included MRI brain injury and complications of hypothermia including over-cooling (lowest temp < 33. 0°C ), hypotension requiring treatment (pressor or steroid), mean blood pressure (MBP) < 40 mmHg, cardiac dysfunction on ECHO, pulmonary hypertension requiring inhaled nitric oxide or ECMO, prolonged ventilator use >7 days, prolonged PT/PTT, and FFP or platelet transfusion. Logistic regression was used in a GEE framework, with adjustment for disease severity and site as clustering variable.

Results: Overall, 294 (58.8%) infants underwent TH with esophageal temperature monitoring, and 206 (41.2%) infants with rectal monitoring. Infants in the esophageal and rectal monitoring groups were similar other than a higher incidence of intubations at birth, Table 1. A higher proportion of infants who received esophageal monitoring were overcooled (57.8% vs. 44.2%, P=0.003). There was also a trend towards higher incidence of hypotension requiring treatment (49.3% vs. 38.0%, p=0.07) and low MBP < 40 mmHg (83.9% vs. 73.5%, p=0.08) in the esophageal group, but these findings were not statistically significant, Table 2. There was no difference in death or NDI or abnormal MRI between esophageal and rectal groups, Table 3.

Conclusion(s): Rate of death or NDI is comparable in infants with HIE undergoing TH by esophageal compared to rectal core temperature monitoring. Infants who received esophageal monitoring had a higher incidence of becoming overcooled. Whether esophageal monitoring gives rise to increased risk of hemodynamic compromise deserves further study.