Effect of persistent pulmonary hypertension on brain oxygenation in asphyxiated term newborns treated with hypothermia

Abstract

Objective: To better understand the impact of persistent pulmonary hypertension (PPHN) on brain oxygenation in term asphyxiated newborns treated with hypothermia.

Methods: The regional cerebral oxygenation saturation (rSO₂) measured by near-infrared spectroscopy was compared to pre/post-ductal oxygen saturation and mean arterial blood pressure in three term asphyxiated newborns with documented PPHN during their first 4 days of life while they were being treated with hypothermia.

Results: The cerebral oxygen saturation remained relatively stable when oxygen saturation was more than 92% and when there was no difference between pre- and post-ductal oxygen saturations. Episodes of desaturations with a difference between pre- and post-ductal saturations, as well as episodes of hypotension, caused a significant decrease in rSO₂ in these newborns.

Conclusion: This case series demonstrates that PPHN has a profound impact on brain oxygenation in term asphyxiated newborns treated with hypothermia during the first days of life after birth. PPHN may represent an additional risk factor for brain injury in these newborns during the first days of life.

• Birth asphyxia
• metabolism
• near-infrared spectroscopy
• neonatal encephalopathy
• newborn brain
• persistent pulmonary hypertension

Acknowledgements

The authors thank the families and their newborns for participating in this study. We thank Mr. Wayne Ross Egers for his professional English correction of the manuscript.

Declaration of interest

This manuscript has been contributed to, seen and approved by all the authors. All the authors fulfill the authorship credit requirements. Pia Wintermark receives research grant funding from the FRSQ Clinical Research Scholar Career Award Junior 1 and the New Investigator Research Grant from the SickKids Foundation and the CIHR Institute of Human Development, Child and Youth Health (IHDCYH). The Fore-sight™ cerebral oximeters (NIRS) were available for the study through in-kind support from Casmed and Caster Medical. The authors have no financial relationships relevant to this article to disclose. The study sponsors had no involvement in the study design, the collection, analysis, and interpretation of data, the writing of the report, or the decision to submit the paper for publication.