The Immediate Impact of Therapeutic Hypothermia on Cardiac Function of Neonates with Hypoxic Ischemic Encephalopathy

Background: It is still debatable whether therapeutic hypothermia (TH) protects the myocardium of neonate with hypoxic-ischemic encephalopathy (HIE).Aim: The study aimed to evaluate the effect of TH on the cardiac function of neonates with HIE by echocardiography. Subjects &Methods: A prospective study was conducted on one hundred neonates with HIE, admitted to our institute Neonatology Unit from April 2022 till April 2023 and were eligible for TH through using Blanketrol-III device or Ice/pack jell method. Clinical profile, laboratory markers of hypoxia and troponin I level were collected. All patients had subjected to three echocardiographic scans along the three clinical phases of TH, before cooling, after 48 hours of active cooling and after rewarming in which data were analyzed and compared. Results: The study population gestational age was; 38±1weeks, birth weight was 3.2 ± 0.4 Kg included: 43% mild, 51% moderate and 6% severe HIE cases. High initial troponin level was found in 54% of cases. The mean of left ventricle ejection fraction (EF), fraction shortening and indices of right ventricle function increased significantly along the clinical phases of TH, P value< 0.001. After cooling, insignificant difference was found between echocardiographic indices in Blanketrol-III subgroup when compared to ICE jell /pack subgroup except in EF and Tei index being improved in Blanketrol-III subgroup, P<0.001 but not normalized. Conclusion: Therapeutic hypothermia (TH) could be cardioprotective in neonates with HIE even with mild encephalopathy. In absence of Blanketrol III device, ICE/Pack method for cooling might be accepted alternative.