HIE: clinical changes over time

HIE: clinical changes over time

Daphna Yasova Barbeau, MDNeonatology Fellow, University of Florida

1. Identify normal trends in laboratory values in neonates with HIE.

2. Define neonates who may need further evaluation for end-organ injury.

3. Associate blood gas findings with glucose values to determine etiology of hypoglycemia and hypocarbia.

Objectives:

0-6

7-12

13-1

8

19-2

4

25-4

8

49-7

272

+

0

1

2

3

4

Sarnat Scores over time

Time (hours)

responders

nonresponders

Score

0-6

7-12

13-1

8

19-2

4

25-4

8

49-7

272

+

0

1

2

3

4

Sarnat Scores over time

Time (hours)

responders

nonresponders

Score

Sarnat Scoring

Sarnat Scoring

Markers of Cardiac Ischemia

resp

onders

nonresp

onders

0

2000

4000

6000

8000

10000

12000

Creatinine Kinase total

responders

nonresponders

CK (U/L)

resp

onders

nonresp

onders

0

100

200

300

CK-MB

responders

nonresponders

CK-MB (U/L)

resp

onders

nonresp

onders

0.0

0.5

1.0

1.5

2.0

Troponin I

responders

nonresponders

Troponin (ng/mL) (p= 0.008)

0-6

7-12

13-1

8

19-2

4

25-4

8

49-7

272

+

6.6

6.8

7.0

7.2

7.4

pH over time

Time (hours)

responders

nonresponders

pH

Acid Base Balance

0-6

7-12

13-1

8

19-2

4

25-4

8

49-7

272

+

0

20

40

60

80

100

CO2 over time

Time (hours)

responders

nonresponders

CO2 (mmHg)

Acid Base Balance

0-6

7-12

13-1

8

19-2

4

25-4

8

49-7

272

+

-5

0

5

10

15

20

25

lactate over time

Time (hours)

responders

nonresponders

Mmol/L

0-6

7-12

13-1

8

19-2

4

25-4

8

49-7

272

+

-30

-20

-10

0

10

Base deficit over time

Time (hours)

responders

nonresponders

BD mmol/L

CO2 and Glucose

0 50 1000

100

200

300

CO2 and glucose

CO2

responders

nonresponders

Glucose (mg/dl)

Renal function

0-6

7-12

19-2

4

25-4

8

49-7

272

+

0.0

0.5

1.0

1.5

CreatinineResponders vs Non Responders

Time (hours)

responders

nonresponders

Creatinine (mg/dL )

0.4

Renal Function

0-24

25-4

8

49-7

272

+

0

Fluid intakeResponders vs. Non Responders

Time (hours)

responders

nonresponders

40-60

60-80

80-100

>100

Fluid intake

(ml/kg/hr)

120

0-24

25-4

8

49-7

272

+

0

Urine outputResponders vs Non Responders

Time (hours)

responders

nonresponders

Urine output (ml/kg/hr)

<1 ml/kg/hr

1-4 ml/kg/hr

4-6 ml/kg/hr

>6 ml/kg/hr

(ml/kg/day)

Urine output (ml/kg/hr)

Aspartate Aminotransferase (AST)

Alanine Aminotransferase (ALT)

0-6

7-12

19-2

4

25-4

8

49-7

272

+

0

50

100

150

200

250

Alanine aminotransferase (ALT)

responders vs non responders

Time (hours)

responders

nonresponders

ALT (U/L)

• Currently no reliable marker of response.

• Infants that don’t follow the trend require further evaluation.

• Electrolyte derangements worsen outcomes.

Summary:

Thank you!Any questions?