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Association between cardiovascular care and neurodevelopmental outcomes in infants with neonatal encephalopathy and hemodynamic instability

Journal of Perinatology volume 45, pages 1073–1080 (2025)Cite this article

Subjects

Abstract

Objective

To analyze the approach to cardiovascular care and long-term outcomes in infants undergoing hypothermia for neonatal encephalopathy (NE).

Study design

This is a retrospective cohort study of 152 infants with NE [SickKids Hospital (Center A, n = 74) or Semmelweis University (Center B, n = 78)], who developed hypotension and underwent neonatal follow-up. Primary outcome was defined as death or neurodevelopmental impairment (<70 on Bayley-II or <85 points on Bayley-III test).

Result

The presence of hypoxic injury in the brain MRI increased the odds of adverse outcome by 10.5 fold. In addition, for every 24 h increase in the duration of cardiovascular support the odds of adverse outcome increased by 12%. In a subgroup of patients with detailed echocardiography evaluation lower tricuspid annulus plane systolic excursion was noted in the non-survivors.

Conclusion

Hypoxic brain injury and longer cardiovascular therapy are independently associated with the adverse long-term outcome in patients with NE.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

KK was supported by the Hungarian Scientific Research Fund, Postdoctoral excellence programme (OTKA PD 142288). AJ was supported by OTKA FK 135222 and TKP2021-EGA25 grants of the National Research, Development and Innovation Office, Hungary. Project no. RRF-2.3.1-21-2022-00011, titled National Laboratory of Translational Neuroscience has been implemented with the support provided by the Recovery and Resilience Facility of the European Union within the framework of Programme Széchenyi Plan Plus. The funding agencies had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Previous presentation: Some parts of our study results were presented at the Pediatric Academic Societies 2024 Meeting in Toronto.

Author information

Author notes

  1. These authors contributed equally: Agnes Jermendy, Patrick J. McNamara.

Authors and Affiliations

  1. Division of Neonatology, Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary

    Kata Kovacs, Zsuzsanna Varga, Miklos Szabo & Agnes Jermendy

  2. Department of Pediatrics, University of Iowa, Iowa city, IA, USA

    Regan E. Giesinger & Patrick J. McNamara

  3. Department of Internal Medicine, University of Iowa, Iowa city, IA, USA

    Patrick J. McNamara

Authors
  1. Kata Kovacs
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  2. Regan E. Giesinger
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  4. Miklos Szabo
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  6. Patrick J. McNamara
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Contributions

KK was responsible for designing the work that led to the submission, analyzing data, interpreting results and drafting the manuscript. REG played an important role in acquiring data and interpreting the results. ZsV, MSz and AJSz contributed to conception, design and interpretation of data and revised the manuscript critically. AJ had substantial contributions to conception and design, acquisition of data, revising the article critically for important intellectual content. PJM, as the corresponding author had full access to the data in the study and had final responsibility for the decision to submit for publication. He also had substantial contributions to conception and design and critically revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Patrick J. McNamara.

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Kovacs, K., Giesinger, R.E., Varga, Z. et al. Association between cardiovascular care and neurodevelopmental outcomes in infants with neonatal encephalopathy and hemodynamic instability. J Perinatol 45, 1073–1080 (2025). https://doi.org/10.1038/s41372-025-02230-3

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