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Early Cerebrovascular Autoregulation in Neonates with Congenital Heart Disease

Celina L Brunsch1, Mirthe J Mebius1, Rolf M F Berger2

  • 1Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands.

Children (Basel, Switzerland)
|November 11, 2022
PubMed

Insights

Neonates with congenital heart disease (CHD) often have impaired cerebrovascular autoregulation (CAR), affecting brain development. This study found impaired CAR in up to 9.3% of the time in the first 72 hours after birth.

Area of Science:

  • Neonatal Neurology
  • Pediatric Cardiology
  • Cerebrovascular Physiology

Background:

  • Congenital heart disease (CHD) is linked to delayed brain development in neonates.
  • Impaired cerebrovascular autoregulation (CAR) and ischemic brain injury are significant risks for these infants.

Purpose of the Study:

  • To analyze the percentage of time with impaired CAR (%time impaired CAR) in the first 72 hours after birth in neonates with CHD.
  • To investigate the relationship between %time impaired CAR and clinical factors, including specific CHD types and medication use.
  • To assess the association between impaired CAR and survival rates in this population.

Main Methods:

  • Studied 57 neonates with CHD within the first 72 hours of life.
  • Calculated the primary outcome as the correlation coefficient between cerebral oxygenation (rcSO2) and mean arterial blood pressure (MABP) over 2-hour periods daily.
  • Analyzed associations between %time impaired CAR and clinical variables, including inotropes, MABP, and specific congenital heart disease types like dextro-transposition of the great arteries (dTGA).

Main Results:

  • Impaired CAR was observed, ranging from 9.3% on day one to 4.6% on day three.
  • Higher %time impaired CAR was associated with the use of inotropes and lower MABP on day one.
  • Dextro-transposition of the great arteries (dTGA) showed a significantly higher %time impaired CAR (16.2%) compared to other CHD types (2.0-5.0%).

Conclusions:

  • Impaired CAR is present in neonates with CHD, affecting brain oxygenation and blood pressure regulation.
  • Inotropes, lower MABP, and dTGA are associated with increased %time impaired CAR.
  • Further research in larger cohorts is needed to understand the long-term implications of impaired CAR in CHD neonates.

Keywords:
arterial pressurebrain injurycerebrovascular circulationcongenital heart diseasehemodynamicsneonatology

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