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  • Clinical Research Article
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Impact of persistent pulmonary hypertension on cerebral oxygenation in infants with neonatal encephalopathy

Pediatric Research volume 98, pages 203–209 (2025)Cite this article

Abstract

Background

Persistent pulmonary hypertension of the newborn (PPHN) affects systemic oxygenation and may worsen brain injury in infants with neonatal encephalopathy (NE). Evidence suggests that higher cerebral regional oxygenation (crSO2) indicates derangement in cerebral autoregulation, energy metabolism, and blood flow following NE. Our aim was to evaluate the impact of PPHN on crSO2, in infants with NE treated with therapeutic hypothermia (TH).

Methods

We retrospectively evaluated infants with NE and PPHN vs without PPHN, between 2018-2022. Linear regression analysis was performed to evaluate the impact of PPHN on crSO2 and total MRI score, adjusted for perinatal factors.

Results

164 infants were analyzed, including 19(12%) with PPHN and 145(88%) without. PPHN-infants had significantly higher crSO2 during rewarming and post-rewarming compared to non-PPHN infants (87 ± 6 vs 80 ± 6, p = 0.001; 87 ± 5 vs 80 ± 7, p = 0.008, respectively), and a significantly higher total MRI score [7(2–19) vs 1(0–3), p < 0.001]. PPHN was significantly associated with higher crSO2 during rewarming (b = 6.21, 95% CI 2.37–10.04, p = 0.002) and post-rewarming (b = 8.60, 95% CI 2.28–14.91, p = 0.009), and total MRI score (b = 7.42, 95% CI 4.88–9.95, p < 0.001).

Conclusions

PPHN was associated with higher crSO2 during and after rewarming, and worse brain MRI score, indicating a significant impact of PPHN on brain injury in infants with NE undergoing TH.

Impact

  • Cerebral oxygenation was significantly higher in infants with neonatal encephalopathy (NE) and persistent pulmonary hypertension (PPHN) compared to infants without PPHN, during the rewarming and post-rewarming periods of therapeutic hypothermia (TH).

  • PPHN is associated with brain injury in infants with NE undergoing TH.

  • In infants with NE and PPHN, monitoring of cerebral oxygenation would help detect infants at higher risk of adverse outcomes.

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Fig. 1: Flowchart of the study population.
Fig. 2: Cerebral oxygenation in infants with and without PPHN, during the three days of TH, the rewarming, and the post-rewarming periods.

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Data availability

The datasets generated and/or analyzed during the current study are not publicly available but are available from the corresponding author upon reasonable request.

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Author information

Authors and Affiliations

  1. Division of Newborn Medicine, Department of Pediatrics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Dimitrios Rallis, Hoda El-Shibiny, Eniko Szakmar, Aisling Garvey, Helen Christou & Mohamed El-Dib

  2. Neonatal Intensive Care Unit, University of Ioannina, Faculty of Medicine, Ioannina, Greece

    Dimitrios Rallis

  3. Harvard Medical School, Boston, MA, USA

    Helen Christou & Mohamed El-Dib

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  1. Dimitrios Rallis
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Contributions

DR, HC, ME: Substantial contributions to conception and design; HE, AG: Acquisition of data; DR, Analysis and interpretation of data and drafting the article or revising it critically for important intellectual content; DR, HE, ES, AG, HC, ME: Final approval of the version to be published.

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Correspondence to Dimitrios Rallis.

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Rallis, D., El-Shibiny, H., Szakmar, E. et al. Impact of persistent pulmonary hypertension on cerebral oxygenation in infants with neonatal encephalopathy. Pediatr Res 98, 203–209 (2025). https://doi.org/10.1038/s41390-024-03718-y

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