Bilateral Transcranial Doppler Monitoring During Neonatal Cardiac Surgery; Guidance for Clinical and Scientific Use

Area of Science:

• Neuroscience
• Cardiovascular Surgery
• Neonatal Medicine

Background:

• Neonates undergoing cardiac surgery are at high risk for neurological injury and neurodevelopmental issues.
• Transcranial Doppler (TCD) monitoring, validated in adults for cerebral blood flow assessment, has potential for neonatal use.
• Widespread introduction of TCD in neonatal cardiac surgery remains limited.

Purpose of the Study:

• To evaluate the feasibility of continuous bilateral transcranial Doppler monitoring.
• To assess cerebral perfusion during neonatal cardiac surgery using TCD.

Main Methods:

• Continuous bilateral TCD monitoring was performed during neonatal cardiac surgery.
• A commercially available TCD system and fixation materials were utilized.
• Cerebral blood flow velocity (CBFV), invasive arterial blood pressure (ABP), and other physiological parameters were continuously measured.

Main Results:

• Bilateral sufficient TCD signal quality was achieved in all 40 evaluable patients at the start of monitoring.
• Unilateral signal deterioration occurred in 2.5% (left MCA) and 7.5% (right MCA) of measurements.
• Mean CBFV decreased during bypass (10.8/10.2 cm/s) compared to pre-bypass (17.2/15.4 cm/s) and post-bypass (18.4/16.1 cm/s).

Conclusions:

• Continuous bilateral TCD monitoring is feasible for assessing cerebral perfusion in neonates during cardiac surgery.
• The technique provides real-time cerebral blood flow information, complementing existing monitoring tools.
• TCD monitoring can be safely implemented within recommended operational limits during these procedures.