Brain injury and neurodevelopmental outcomes in children undergoing surgery for congenital heart disease.

Autor:	Reitz JG; Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, University Hospital Giessen and Marburg, Justus-Liebig University Giessen, Giessen, Germany., Zurakowski D; Departments of Surgery and Anesthesiology, Boston Children's Hospital, Harvard Medical School, Boston, Mass., Kuhn VA; Division of Prenatal Medicine and Fetal Therapy, Department of Obstetrics and Gynecology, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany., Murnick J; Division of Neuroradiology, Department of Radiology, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC., Donofrio MT; Division of Cardiology, Children's National Medical Center, Washington, DC., d'Udekem Y; Department of Cardiovascular Surgery, Children's National Medical Center, Washington, DC., Licht D; Department of Neurology, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC., Kosiorek A; Diagnostic and Interventional Radiology, University Hospital Zurich, University Zurich, Zurich, Switzerland., Limperopoulos C; Institute for the Developing Brain, Children's National Hospital, Washington, DC., Axt-Fliedner R; Division of Prenatal Medicine and Fetal Therapy, Department of Obstetrics and Gynecology, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany., Yerebakan C; Department of Neurology, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC., Carpenter JL; Division of Pediatric Neurology, Departments of Pediatrics and Neurology, University of Maryland, Baltimore, Md.
Jazyk:	angličtina
Zdroj:	JTCVS open [JTCVS Open] 2023 Dec 04; Vol. 17, pp. 229-247. Date of Electronic Publication: 2023 Dec 04 (Print Publication: 2024).
DOI:	10.1016/j.xjon.2023.11.018
Abstrakt:	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. Competing Interests: The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. (© 2023 The Author(s).)
Databáze:	MEDLINE
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