Postoperative Cerebral Oxygen Saturation in Children After Congenital Cardiac Surgery and Long-Term Total Intelligence Quotient: A Prospective Observational Study
Open Access
- 12 February 2021
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 49 (6), 967-976
- https://doi.org/10.1097/ccm.0000000000004852
Abstract
Objectives: During the early postoperative period, children with congenital heart disease can suffer from inadequate cerebral perfusion, with possible long-term neurocognitive consequences. Cerebral tissue oxygen saturation can be monitored noninvasively with near-infrared spectroscopy. In this prospective study, we hypothesized that reduced cerebral tissue oxygen saturation and increased intensity and duration of desaturation (defined as cerebral tissue oxygen saturation < 65%) during the early postoperative period, independently increase the probability of reduced total intelligence quotient, 2 years after admission to a PICU. Design: Single-center, prospective study, performed between 2012 and 2015. Setting: The PICU of the University Hospitals Leuven, Belgium. Patients: The study included pediatric patients after surgery for congenital heart disease admitted to the PICU. Interventions: None. Measurements and Main Results: Postoperative cerebral perfusion was characterized with the mean cerebral tissue oxygen saturation and dose of desaturation of the first 12 and 24 hours of cerebral tissue oxygen saturation monitoring. The independent association of postoperative mean cerebral tissue oxygen saturation and dose of desaturation with total intelligence quotient at 2-year follow-up was evaluated with a Bayesian linear regression model adjusted for known confounders. According to a noninformative prior, reduced mean cerebral tissue oxygen saturation during the first 12 hours of monitoring results in a loss of intelligence quotient points at 2 years, with a 90% probability (posterior β estimates [80% credible interval], 0.23 [0.04–0.41]). Similarly, increased dose of cerebral tissue oxygen saturation desaturation would result in a loss of intelligence quotient points at 2 years with a 90% probability (posterior β estimates [80% credible interval], –0.009 [–0.016 to –0.001]). Conclusions: Increased dose of cerebral tissue oxygen saturation desaturation and reduced mean cerebral tissue oxygen saturation during the early postoperative period independently increase the probability of having a lower total intelligence quotient, 2 years after PICU admission.This publication has 31 references indexed in Scilit:
- Evaluation of Cognitive and Motor Development in Toddlers With Congenital Hypothyroidism Diagnosed by Neonatal ScreeningJournal of Developmental & Behavioral Pediatrics, 2012
- Near-infrared spectroscopy as a hemodynamic monitor in critical illnessPediatric Critical Care Medicine, 2011
- Neurocognitive outcome 12 months following cerebellar mutism syndrome in pediatric patients with medulloblastomaNeuro-Oncology, 2010
- Relationship of Intraoperative Cerebral Oxygen Saturation to Neurodevelopmental Outcome and Brain Magnetic Resonance Imaging at 1 Year of Age in Infants Undergoing Biventricular RepairCirculation, 2010
- Normal cerebral, renal and abdominal regional oxygen saturations using near-infrared spectroscopy in preterm infantsJournal of Perinatology, 2010
- Cerebral Oxygen Desaturation Predicts Cognitive Decline and Longer Hospital Stay After Cardiac SurgeryThe Annals of Thoracic Surgery, 2009
- Brain magnetic resonance imaging abnormalities after the Norwood procedure using regional cerebral perfusionThe Journal of Thoracic and Cardiovascular Surgery, 2005
- The significance of baseline cerebral oxygen saturation in children undergoing congenital heart surgeryThe American Journal of Surgery, 2005
- Periventricular leukomalacia is common after neonatal cardiac surgeryThe Journal of Thoracic and Cardiovascular Surgery, 2004
- Cognitive and motor development in preschool and school-aged children after neonatal arterial switch operationThe Journal of Thoracic and Cardiovascular Surgery, 1997