Predictive value of near-infrared spectroscopy on neurodevelopmental outcome after surgery for congenital heart disease in infancy

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• 作者：Julie Simons ; PhD^a ; ^b ; Erica D. Sood ; PhD^a ; ^b ; ^{esood@nemours.org} ; Christopher D. Derby ; MD^a ; Christian Pizarro ; MD^a
• 关键词：19 ; 20
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：2012
• 出版时间：January, 2012
• 年：2012
• 卷：143
• 期：1
• 页码：118-125
• 全文大小：156 K

文摘

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Objective

To explore the relationship between intraoperative regional cerebral oxygen saturation (rSO₂) measured by near-infrared spectroscopy (NIRS) and neurodevelopmental outcome in children after cardiac surgery.

Methods

Cross-sectional neurodevelopmental evaluation at 2 years of age was performed in a cohort of young infants who had surgery for congenital heart disease in 2007. The third edition of Bayley Scales of Infant and Toddler Development (Bayley-III) was used to assess cognitive, language, and motor functioning. Clinical and perioperative data were collected, including intraoperative rSO₂ nadir, rSO₂ percent decrease from baseline, and cumulative minutes of at least 20 % , 30 % , and 40 % decrease from baseline.

Results

Twenty-seven patients without chromosomal abnormality were included in analyses. Mean Bayley-III scores fell within 1 standard deviation of the normative mean. Stepwise regression analyses of patient- and procedure-related variables, including rSO₂, demonstrated that cognitive ability was predicted by length of hospital stay and premature birth (58.1 % of variance), receptive communication was predicted by length of hospital stay and rSO₂ nadir (40.2 % of variance), expressive communication was predicted by birth weight (26.2 % of variance), fine motor functioning was predicted by duration of cardiac intensive care unit stay (41.4 % of variance), and gross motor functioning was predicted by the presence of a significant comorbidity (43.5 % of variance).

Conclusions

In a contemporary cohort of infants undergoing surgery for congenital heart disease, neurodevelopmental outcomes at 2 years of age are largely influenced by patient-related characteristics. Although receptive communication appears to be influenced by rSO₂ nadir, the predictive value of NIRS remains unclear.