118 - Early Cardiovascular Physiological Profiling of neonates with Impaired Right Ventricular in the Setting of Hypoxic Ischemic Encephalopathy and Therapeutic Hypothermia.

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 118
Publication Number: 118.427

Regan Giesinger, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States; Rawan Al-Rawi, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, United States; Nadine Kibbi, University of Iowa, Iowa City, IA, United States; Daniel Dagle, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States; Danielle R. Rios, University of Iowa Department of Pediatrics, Iowa City, IA, United States; Patrick J. McNamara, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, United States

Presenting Author(s)

Regan E. Giesinger, MD FRCPC FASE (she/her/hers)

Clinical Associate Professor
University of Iowa Stead Family Children's Hospital
Iowa City, Iowa, United States

Background: Persistent right ventricular (RV) dysfunction in neonates with hypoxic ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH) is associated with poor short and long-term outcomes; however, the acute clinical relevance has not been systematically studied. SickBay is a predictive analytics platform which may be used to evaluate vital sign patterns. Physiologic profiling may facilitate earlier detection of neonates with impaired heart function.

Objective: To determine whether a physiological difference in vital signs [components of arterial pressure (AP), heart rate (HR), oxygen saturation (SpO₂)] exists between HIE patients with and without right ventricular (RV) dysfunction during TH in the first 24 postnatal hours.

Design/Methods: A cohort (≥36 weeks) admitted to the University of Iowa Neonatal Intensive Care Unit from 1/20-6/22 for HIE and undergoing TH, who were monitored with the SickBay platform, was studied. Per clinical protocol all neonates underwent comprehensive screening echocardiography including quantification of RV systolic performance prior to 48h postnatal age. RV dysfunction was defined as tricuspid annulus systolic excursion ≤6mm. Continuous arterial pressure (systolic, mean, and diastolic), HR and SpO₂was extracted. SickBay data were filtered to remove non-physiologic values. Histograms and boxplots were developed to display the distribution and clustering of vital sign values respectively. The median and interquartile range were compared between groups with and without RV dysfunction. P< 0.05 was significant.

Results: A total of 58 patients [RV dysfunction (n=18), controls (n=40)] were included. Demographics and delivery characteristics were similar between groups.[Table 1] Cardiovascular and respiratory illness severity was higher among patients with RV dysfunction, whereas markers of renal and hepatic dysfunction were similar.[Table 1] Figure 1 demonstrates clustering of vital sign signals for the RV dysfunction group vs controls. While within the “normal range”, all components of AP were lower, HR was higher and SpO₂ lower in the RV dysfunction group. Figure 2 demonstrates the distribution of vital sign values. Infants with RV dysfunction demonstrate a wider distribution and a higher proportion of lower signals across all parameters measured.

Conclusion(s): Physiologic patterns of routine vital signs differ in patients with RV dysfunction in the setting of HIE and TH. These data confirm the immediate clinical relevance of RV dysfunction and suggest that predictive analytics may be used to guide the selection of patients for echocardiography

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