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Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model
Published on: May 26, 2023
Brain injury and neurodevelopmental outcomes in children undergoing surgery for congenital heart disease
Justus G Reitz1, David Zurakowski2, Viktoria A Kuhn3
1Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, University Hospital Giessen and Marburg, Justus-Liebig University Giessen, Giessen, Germany.
Insights
New brain stroke on MRI after infant heart surgery predicts poor neurodevelopmental outcomes. Postoperative lactate levels also indicate adverse outcomes in these children.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Pediatrics
- Pediatric Neurology
Background:
- Brain injury is frequently observed via magnetic resonance imaging (MRI) in infants with complex congenital heart disease (CHD).
- The long-term effects of perioperative brain injury on neurodevelopmental outcomes in this population remain incompletely understood.
- This study investigates the relationship between brain injury and neurodevelopmental outcomes in infants undergoing cardiac surgery.
Purpose of the Study:
- To evaluate the association of perioperative brain injury, identified through MRI, with neurodevelopmental outcomes in infants undergoing surgery for congenital heart disease.
- To identify independent risk factors for poor neurodevelopmental outcomes in this patient cohort.
Main Methods:
- A cohort of 122 term newborns undergoing cardiac surgery between 2008 and 2019 was analyzed.
- Preoperative and postoperative brain MRI scans were obtained; patients with genetic conditions were excluded.
- Neurodevelopmental outcomes were assessed using the Pediatric Stroke Outcome Measure and Glasgow Outcome Scale Extended, with multivariable Cox regression used to identify risk factors.
Main Results:
- New or progressive postoperative brain injury was present in 69 patients (57%).
- Early neurodevelopmental assessments (5-24 months) were available for 95 children.
- New stroke on postoperative MRI was an independent predictor of poor early neurodevelopmental outcomes. Postoperative peak lactate also predicted poor outcomes.
Conclusions:
- New stroke detected by MRI following infant congenital heart surgery is a significant predictor of poor neurodevelopmental outcomes in early childhood.
- Postoperative lactic acidosis may serve as a surrogate biomarker for ischemic brain injury and is associated with adverse neurodevelopmental outcomes.
Objectives:
Brain injury is commonly seen on magnetic resonance imaging in infants with complex congenital heart disease. The impact of perioperative brain injury on neurodevelopmental outcomes is not well understood. We evaluate the association of brain injury and other markers on neurodevelopmental outcomes in patients undergoing surgery for congenital heart surgery during infancy.
Methods:
Term newborns with infant cardiac surgery performed between 2008 and 2019 at a single tertiary center, and both preoperative and postoperative brain magnetic resonance imaging were included. Those with underlying genetic conditions were excluded. Brain injury was characterized using an magnetic resonance imaging scoring system. Neurodevelopmental outcomes were assigned using the Pediatric Stroke Outcome Measure and Glasgow Outcome Scale Extended. Independent risk factors for poor neurodevelopmental outcomes were determined by multivariable Cox regression.
Results:
A total of 122 patients were included. New or progressive postoperative brain injury was noted in 69 patients (57%). A total of 101 patients (83%) had at least 1 neurodevelopmental assessment (median age 36 months) with an early assessment (5-24 months) performed in 95 children. Multivariable Cox regression analysis of early neurodevelopmental outcomes identified new stroke on postoperative magnetic resonance imaging to be an independent predictor of poor neurodevelopmental outcome. Postoperative peak lactate was an independent predictor of poor outcome assessed by the Pediatric Stroke Outcome Measure and Glasgow Outcome Scale Extended.
Conclusions:
Our study reveals that evidence of new stroke on magnetic resonance imaging after infant congenital heart surgery is a predictor of poor neurodevelopmental outcomes in early childhood. Postoperative lactic acidosis is associated with poor neurodevelopmental outcome and may be a surrogate biomarker for ischemic brain injury.
