The impact of cerebral embolization during infant cardiac surgery on neurodevelopmental outcomes at intermediate follow-up
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Published on: April 21, 2017
R J Naik1, J B Wagner1, D Chowdhury1
1Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA.
Insights
Cerebral embolic signals during infant heart surgery did not correlate with neurodevelopmental outcomes in a small study. Further research is needed to understand the impact of these signals on children's neurological development.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Science
- Medical Ultrasonography
Background:
- Cerebral embolization during pediatric cardiac surgery is a potential cause of neurodevelopmental impairment.
- Transcranial Doppler (TCD) ultrasound can monitor for intraoperative cerebral embolization.
Purpose of the Study:
- To investigate the association between intraoperative cerebral embolic signals (CES) detected by TCD and neurodevelopmental outcomes in infants undergoing cardiac surgery.
- To test the hypothesis that increased CES correlate with poorer neurodevelopmental outcomes.
Main Methods:
- A cohort of 24 children undergoing infant cardiac surgery with TCD monitoring was assessed.
- Neurodevelopmental assessment included cognitive tests and behavioral questionnaires at intermediate follow-up.
- Statistical analysis correlated the number of CES during surgery with neurodevelopmental assessment results.
Main Results:
- Analysis of 67 parameters revealed five significant associations with CES, but in the opposite direction of the hypothesis, suggesting Type I error.
- The number of CES during surgery was not associated with worse neurodevelopmental outcomes in this cohort.
Conclusions:
- In this small study, intraoperative CES during infant cardiac surgery were not linked to adverse neurodevelopmental outcomes.
- The clinical significance of CES in pediatric cardiac surgery remains uncertain and requires larger studies for definitive conclusions.
Abstract:
Cerebral embolization during pediatric cardiac surgery may be an underappreciated source of subsequent neurodevelopmental impairment. Transcranial Doppler ultrasound is a neuromonitoring tool that can provide intraoperative surveillance for cerebral embolization. We hypothesized that increased cerebral embolic signals detected during infant cardiac surgery would be associated with worse neurodevelopmental outcomes at follow-up. A study group of 24 children who underwent infant cardiac surgery with transcranial Doppler detection of cerebral embolic signals returned at intermediate follow-up for standardized neurodevelopmental assessment. The children were evaluated using two neurocognitive tests and the parents completed two questionnaires regarding observed behavior. Statistical analysis assessed for correlation between the number of cerebral embolic signals at surgery and the results of the neurodevelopmental assessment. Of the 67 test parameters analyzed, five showed a significant association with the number of embolic signals, yet, all in the contrary direction of the clinical hypothesis, likely representing a Type I error. Thus, in this small cohort of patients, the number of cerebral embolic signals detected during infant cardiac surgery was not shown to be associated with worse neurodevelopmental outcomes at intermediate follow-up. A larger study is probably necessary to ascertain the potential influence of cerebral embolic signals on eventual neurologic outcomes in children. The clinical relevance of cerebral embolic signals during pediatric cardiac surgery remains undetermined and deserves further investigation.
