Day-2 echocardiography and cardiovascular biomarkers measurements in neonates with hypoxic-ischemic encephalopathy with or without brain injury

Objective: To assess the association between day-2 cardiac function and brain injury in neonates with HIE undergoing therapeutic hypothermia. Study design: A prospective single-center study (2016–2021) including neonates ≥36 weeks gestation with moderate to severe HIE treated with TH. Brain injuries were evaluated using MRI and a validated scoring system, and logistic regression identified cardiovascular predictors. Results: Among 55 neonates, 33 (60%) had brain injuries. Day-2 ventricular dysfunction was found in 16 (29%). Neonates with brain injuries had higher gestational age, more severe aEEG patterns, and higher Sarnat scores. Significant predictors of brain injury included higher gestational age, severe initial aEEG patterns, and increased left ventricular strain. No significant differences were observed in standard echocardiography measurements. Conclusion: Severe initial aEEG patterns and increased left ventricular strain, rather than day-2 cardiac dysfunction, were more predictive of brain injury in HIE neonates. Early assessments may further clarify the role of hemodynamics.