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Published on: July 18, 2014
Cerebral Autoregulation in Neonates With and Without Congenital Heart Disease
Nhu N Tran1, S Ram Kumar2, Felicia S Hodge2
1Nhu N. Tran is a clinical research nurse III, Department of Cardiothoracic Surgery, Children's Hospital Los Angeles, Los Angeles, California. Ram Kumar is an assistant professor of surgery, Keck School of Medicine, University of Southern California, Los Angeles, California. Felicia S. Hodge is a professor and Paul M. Macey is an associate professor, School of Nursing, University of California, Los Angeles. ntran@chla.usc.edu.
Insights
Neonates with congenital heart disease (CHD) show poorer neurodevelopmental outcomes and more hypoxemia, despite similar cerebral autoregulation compared to healthy infants. This highlights early developmental challenges in infants with CHD.
Area of Science:
- Pediatric Cardiology
- Neonatal Neurology
- Developmental Pediatrics
Background:
- Congenital heart disease (CHD) affects approximately 40,000 neonates annually in the US.
- Neurological deficits in children with CHD persist into adulthood, impacting quality of life.
Purpose of the Study:
- To investigate cerebral autoregulation and neurodevelopmental outcomes in neonates with CHD.
- To compare these outcomes against healthy control neonates.
Main Methods:
- 44 full-term neonates (28 with CHD, 16 controls) were studied.
- Cerebral autoregulation assessed via regional cerebral oxygenation during postural change.
- Neurodevelopmental outcomes measured using the Einstein Neonatal Neurobehavioral Assessment Scale.
Main Results:
- No significant difference in impaired cerebral autoregulation between neonates with CHD and controls.
- Neonates with CHD exhibited lower regional cerebral oxygenation (hypoxemia).
- CHD group showed poorer total and motor neurodevelopmental scores, even after adjusting for cerebral autoregulation.
Conclusions:
- Preoperative neonates with CHD experience poorer developmental outcomes and hypoxemia compared to controls.
- Early identification and intervention are crucial for managing neurodevelopmental deficits in infants with CHD.
Background:
Congenital heart disease (CHD) is a leading birth defect in the United States, affecting about 40 000 neonates each year. Despite efforts to prevent developmental delays, many children with CHD have neurological deficits that last into adulthood, influencing employability, self-care, and quality of life.
Objective:
To determine if neonates with CHD have impaired cerebral autoregulation and poorer neurodevelopmental outcomes compared with healthy controls.
Methods:
A total of 44 full-term neonates, 28 with CHD and 16 without, were enrolled in the study. Inclusion criteria included confirmed diagnosis of CHD, stable hemodynamic status, and being no more than 12 days old. Exclusion criteria included intraventricular hemorrhage and intubation. Cerebral autoregulation was determined by measuring regional cerebral oxygenation during a postural change. The Einstein Neonatal Neurobehavioral Assessment Scale was used to measure overall neurodevelopmental outcomes (motor, visual, and auditory functions).
Results:
Of the 28 neonates with CHD, 8 had single-ventricle physiology. A χ2 analysis indicated no significant difference in impaired cerebral autoregulation between neonates with CHD and controls (P = .38). Neonates with CHD had lower regional cerebral oxygenation than did neonates without CHD (P < .001). Regression analyses with adjustments for cerebral autoregulation indicated that neonates with CHD had poorer total neurodevelopmental outcomes scores (β = 9.3; P = .02) and motor scores (β = 7.6; P = .04).
Conclusion:
Preoperative neonates with CHD have poorer developmental outcomes and more hypoxemia than do controls.
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