Risk Factors for Postoperative New Brain Injury in Infants and Young Children With Congenital Heart Disease

Postoperative brain injury in congenital heart disease (CHD) impairs neurodevelopment. We aimed to identify risk factors for postoperative brain injury in infants and young children with CHD and explore age- and cyanosis-related patterns.

Infants and young children undergoing open-heart surgery with preoperative and postoperative brain magnetic resonance imaging were retrospectively enrolled. Postoperative new brain injury (intracranial hemorrhage, white matter injury, stroke, venous thrombosis) was assessed. Demographic, intraoperative, intensive care, hematological, and echocardiographic data were collected. Participants were classified according to the presence or absence of new postoperative brain injury. Differences between groups were assessed using independent t test, Mann-Whitney U, and chi-square testing, as appropriate. Multivariable logistic regression (exclusion criteria P > 0.1) was used to identify risk factors for new postoperative brain injury, supplemented by stratification analyses based on age categories and cyanotic status.

Among 172 infants and young children (35.5% with new brain injury), independent risk factors included older age (odds ratio [OR] = 1.049), longer cardiopulmonary bypass (CPB) time (OR = 1.029), smaller main pulmonary artery diameter (OR = 0.800), lower postoperative mean corpuscular hemoglobin concentration (OR = 0.779), and lower platelet count (OR = 0.993). Stratified analyses revealed age-cyanosis interactions: in noncyanotic children ≤365 days, younger age, lower platelets and mean corpuscular hemoglobin concentration increased risk; in noncyanotic children >365 days, prolonged CPB was dominant; cyanotic subgroups showed borderline age and sex effects.

Postoperative brain injury risk in children with CHD follows age-dependent and cyanosis-stratified patterns. Modifiable predictors include CPB duration and perioperative hematological parameters, enabling tailored neuroprotective strategies.