Case of HIE - October 2024

A hemodynamics assessment was performed on day 2 of life. At this point, the blood pressure was 61/43. The baby was on 35% FiO2 with saturations 99 in pre and 93 in post-ductal areas. On NIRS, the cerebral saturation was 88 and the renal saturation was 85. Hemoglobin was 130. The baby had be started on iNO 20 ppm by the medical team due to pre-post ductal saturation differences. At the time of the evaluation, the patient had received fresh frozen plasma for a high INR and signs of coagulopathy on the coagulogram and was hyponatremia (116 of sodium), despite restriction of the total fluid intake to 45 mL/kg/day. Urine output was 0.5 - 1 mL/kg/hr. 

UAL Gaz arterial: 7.38 / CO2: 31 / Bic 17.5 / BE: -7 / PaO2: 126. Lactate 2.8. Calcium 1.05 mmol/L. 

Baby had a capillary refill of 3 seconds on therapeutic hypothermia but with good central pulses. The baby was non-reactive to manipulation. No liver edge was palpated on exam and auscultation of heart sounds was benign. Heart rate was 120-130 beats per minute.

A TnECHO was performed on iNO 20 ppm. What would be your interpretation and management ? Images and clips are below:

Please provide your interpretation and management plan here