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Oxygen saturations and neurodevelopmental outcomes in single ventricle heart disease

Kelly R Wolfe1, John Brinton2, Michael V Di Maria3

  • 1Pediatric Neurology, University of Colorado School of Medicine and Children's Hospital, Aurora, Colorado.

Pediatric Pulmonology
|March 29, 2019
PubMed

Insights

Post-surgery oxygen levels in single ventricle heart disease do not predict neurodevelopmental outcomes. Pulse oximetry may not be a reliable indicator of brain oxygen delivery in these children.

Area of Science:

  • Pediatric Cardiology
  • Neurodevelopmental Pediatrics
  • Congenital Heart Disease Research

Background:

  • Single ventricle congenital heart disease (SVCHD) requires complex palliative surgeries.
  • Neurodevelopmental outcomes in children with SVCHD are a significant concern.
  • Predicting neurodevelopmental trajectories after palliative interventions is crucial for clinical management.

Purpose of the Study:

  • To determine if hypoxemia after stage-I and stage-II palliative surgeries predicts neurodevelopmental outcomes at 14 months in children with SVCHD.
  • To assess the association between post-operative oxygen saturation levels and cognitive development in infants with SVCHD.

Main Methods:

  • Analysis of longitudinal data from 328 subjects in two Pediatric Heart Network (PHN) randomized controlled trials.
  • Oxygen saturations post-discharge from stage-I and stage-II surgeries were primary predictors.
  • Bayley Scales of Infant Development-II (BSID-II) scores at 14 months were the primary outcome measure, with covariate inclusion.

Main Results:

  • Oxygen saturations at discharge after stage-I and stage-II surgeries were not associated with BSID-II scores.
  • Low oxygen saturation measurements (below 80%) or changes over time did not correlate with neurodevelopmental outcomes.
  • These findings remained consistent even after including relevant covariates in regression models.

Conclusions:

  • Post-operative oxygen saturation levels, as measured by pulse oximetry, do not predict 14-month neurodevelopmental outcomes in children with SVCHD.
  • Pulse oximetry may be an inadequate measure of cerebral oxygen delivery, and the relationship between oxygenation and neurodevelopment in SVCHD is complex.
  • Clinical use of pulse oximetry readings during interstage and post-stage-II periods is not a reliable predictor of future neurodevelopmental risk in this population.
Abstract

Keywords:
blood oxygenationneurodevelopmentpediatric heart networkpulse oximetrysingle ventricle

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