(61) The Impact of Universal Targeted Neonatal Echocardiography Screening on Hemodynamic Stability Among Neonates Undergoing Therapeutic Hypothermia

Background: Impaired RV performance, in the setting of hypoxic ischemic encephalopathy (HIE) is associated with death and adverse neurodevelopmental outcomes. The approach to cardiovascular care is imprecise and the impact of early detection of RV dysfunction and targeted neonatal echocardiography (TNE) on clinical outcomes is unknown. At our institution, universal hemodynamic screening (HS), including mandatory TNE in the first 24 hours after birth, was implemented in June 2019.

Objectives: To determine differences in neonatal cardiovascular care following the addition of universal hemodynamic screening with Targeted Neonatal Echocardiography in patients with hypoxic ischemic encephalopathy undergoing therapeutic hypothermia at the University of Iowa.

Design/Methods: A retrospective cohort study (July 2013-April 2024) of infants with moderate-severe HIE undergoing therapeutic hypothermia at University of Iowa Stead Family Children’s Hospital was conducted. Patients were analyzed based on epoch: pre-HS (July 2013-June 2019) and post-HS (June 2019-April 2024) screening. Baseline demographics, clinical characteristics and short-term cardiovascular outcomes were assessed. Standard univariate analysis were performed to compare both epochs.

Results: The post-HS epoch was characterized by lower gestational age, rate of chest compressions, duration of bag/mask ventilation and rate of clinical seizures. (Table 1) Pulmonary hypertension and right ventricular dysfunction were more commonly diagnosed in the post-HS epoch (Table 2). Overall use of cardiovascular medications was similar, but the pre-HS epoch had a higher rate of vasopressors (e.g., dopamine) while the post-HS epoch had a higher use of inotropes (e.g., dobutamine and epinephrine) (Table 3).

Conclusions: Hemodynamic screening was associated with increased recognition of pulmonary hypertension and right ventricular dysfunction. There was a transition from a dopamine-predominant approach to inotrope-predominant use in the HS-era, however the long-term impacts of this transition remains unknown and can be studied further.