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Association Between Method of Cerebral Protection During Neonatal Aortic Arch Surgery and Attention
Joseph J Sistino1, Andrew M Atz2, Charles Ellis1
1College of Health Professions, Medical University of South Carolina, Charleston, South Carolina.
Insights
Attention deficit/hyperactivity disorder (ADHD) is common in neonates after aortic arch surgery. This study found interrupted aortic arch significantly increased ADHD risk, with no clear benefit of deep hypothermic circulatory arrest or regional cerebral perfusion.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Pediatrics
- Congenital Heart Surgery
Background:
- Neonates undergoing aortic arch repair face risks of neurodevelopmental issues, including ADHD.
- Understanding factors influencing ADHD post-surgery is crucial for long-term patient outcomes.
Purpose of the Study:
- To compare the impact of deep hypothermic circulatory arrest versus regional cerebral perfusion on long-term ADHD outcomes.
- To determine the prevalence of ADHD in children following neonatal aortic arch surgery.
Main Methods:
- Cross-sectional observational study involving children who had neonatal aortic arch surgery.
- Utilized Attention Deficit/Hyperactivity Disorder-IV surveys for ADHD prevalence assessment.
- Reviewed medical records for cerebral protection methods and surgical variables.
Main Results:
- 44% of surveyed children (57/134) were classified as having ADHD.
- Children with interrupted aortic arch showed the highest ADHD prevalence (85%).
- Interrupted aortic arch correlated with higher ADHD inattention scores and lower psychosocial scores.
Conclusions:
- ADHD is prevalent following neonatal aortic arch surgery, potentially linked to genetic factors.
- No significant evidence emerged to suggest deep hypothermic circulatory arrest or regional cerebral perfusion reduces ADHD risk.
- Interrupted aortic arch is a key risk factor for ADHD in this population.
Background:
Neonates undergoing repair of the aortic arch are at risk for adverse neurodevelopmental outcomes, including attention deficit/hyperactivity disorder (ADHD). The purpose of this study was to compare the effect of deep hypothermic circulatory arrest versus regional cerebral perfusion on the long-term outcome of ADHD.
Methods:
This study is a cross-sectional observational study of ADHD in children who underwent neonatal aortic arch surgery. Attention Deficit/Hyperactivity Disorder-IV surveys were used to determine the prevalence of ADHD. Review of the medical records was performed to determine the primary method of cerebral protection and to extract related surgical variables.
Results:
Surveys were sent to parents of 134 children, with 57 surveys completed (43%). The percentage of children classified as having ADHD was 44%. Children with a diagnosis of interrupted aortic arch had the highest prevalence of ADHD (85%). Multivariate analysis demonstrated that interrupted aortic arch was associated with an increased ADHD inattention score (p < 0.01), and a decreased Child Health Questionnaire-50 psychosocial score (p < 0.01). Low Child Health Questionnaire-50 psychosocial summary scores are associated with increased behavioral problems and are lower in patients with ADHD.
Conclusions:
Attention deficit/hyperactivity disorder is common after neonatal aortic arch surgery and may be primarily related to genetic predisposition. We found insufficient evidence to show that either deep hypothermic circulatory arrest or regional cerebral perfusion decreased the risk of ADHD.
