Temporal and Anatomic Risk Profile of Brain Injury With Neonatal Repair of Congenital Heart Defects
- 1 February 2007
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 38 (2), 736-741
- https://doi.org/10.1161/01.str.0000247941.41234.90
Abstract
Background and Purpose— Brain injury is common in newborns with congenital heart disease (CHD) requiring neonatal surgery. The purpose of this study is to define the risk factors for preoperative and postoperative brain injuries and their association with functional cardiac anatomic groups. Methods— Sixty-two neonates with CHD were studied with preoperative MRI, and 53 received postoperative scans. Clinical and therapeutic characteristics were compared in newborns with and without newly acquired brain injuries. A subset of 16 consecutive patients was monitored with intraoperative cerebral near-infrared spectroscopy. Results— Brain injury was observed in 56% of patients. Preoperative brain injury, seen in 39%, was most commonly stroke and was associated with balloon atrial septostomy ( P =0.002). Postoperative brain injury, seen in 35%, was most commonly white matter injury and was particularly common in neonates with single-ventricle physiology and aortic arch obstruction ( P =0.001). Risk factors associated with acquired postoperative brain injury included cardiopulmonary bypass (CPB) with regional cerebral perfusion ( P =0.01) and lower intraoperative cerebral hemoglobin oxygen saturation during the myocardial ischemic period of CPB ( P =0.008). In a multivariable model, new postoperative white matter injury was specifically associated with low mean blood pressure during the first postoperative day ( P =0.04). Conclusions— Specific modifiable risk factors can be identified for preoperative and postoperative white matter injury and stroke associated with neonatal surgery for CHD. The high incidence of postoperative injury observed despite new methodologies of CPB indicates the need for ongoing evaluation to optimize neurological outcome.Keywords
This publication has 20 references indexed in Scilit:
- Current Assessment of Mortality Rates in Congenital Cardiac SurgeryThe Annals of Thoracic Surgery, 2006
- Pyramidal tract maturation after brain injury in newborns with heart diseaseAnnals of Neurology, 2006
- Balloon Atrial Septostomy Is Associated With Preoperative Stroke in Neonates With Transposition of the Great ArteriesCirculation, 2006
- Current insights regarding neurological and developmental abnormalities in children and young adults with complex congenital cardiac diseaseCardiology in the Young, 2006
- Early Brain Injury in Premature Newborns Detected with Magnetic Resonance Imaging is Associated with Adverse Early Neurodevelopmental OutcomeThe Journal of Pediatrics, 2005
- Cerebral oxygen balance is impaired during repair of aortic coarctation in infants and childrenThe Journal of Thoracic and Cardiovascular Surgery, 2005
- Patterns of brain injury in term neonatal encephalopathyThe Journal of Pediatrics, 2005
- Preoperative brain injury in newborns with transposition of the great arteriesThe Annals of Thoracic Surgery, 2004
- Selective vulnerability in the developing central nervous systemPediatric Neurology, 2004
- Magnetic resonance imaging compatible neonate incubatorConcepts in Magnetic Resonance, 2002