Andropoulos Dean B, Ahmad Hasan B, Haq Taha, Brady Ken, Stayer Stephen A, Meador Marcie R, Hunter Jill V, Rivera Carlos, Voigt Robert G, Turcich Marie, He Cathy Q, Shekerdemian Lara S, Dickerson Heather A, Fraser Charles D, Dean McKenzie E, Heinle Jeffrey S, Blaine Easley R
Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Pediatric Cardiovascular Anesthesiology, Texas Children's Hospital, Houston, TX, USA.
Paediatr Anaesth. 2014 Mar;24(3):266-74. doi: 10.1111/pan.12350.
Adverse neurodevelopmental outcomes are observed in up to 50% of infants after complex cardiac surgery. We sought to determine the association of perioperative anesthetic exposure with neurodevelopmental outcomes at age 12 months in neonates undergoing complex cardiac surgery and to determine the effect of brain injury determined by magnetic resonance imaging (MRI).
Retrospective cohort study of neonates undergoing complex cardiac surgery who had preoperative and 7-day postoperative brain MRI and 12-month neurodevelopmental testing with Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). Doses of volatile anesthetics (VAA), benzodiazepines, and opioids were determined during the first 12 months of life.
From a database of 97 infants, 59 met inclusion criteria. Mean ± sd composite standard scores were as follows: cognitive = 102.1 ± 13.3, language = 87.8 ± 12.5, and motor = 89.6 ± 14.1. After forward stepwise multivariable analysis, new postoperative MRI injury (P = 0.039) and higher VAA exposure (P = 0.028) were associated with lower cognitive scores. ICU length of stay (independent of brain injury) was associated with lower performance on all categories of the Bayley-III (P < 0.02).
After adjustment for multiple relevant covariates, we demonstrated an association between VAA exposure, brain injury, ICU length of stay, and lower neurodevelopmental outcome scores at 12 months of age. These findings support the need for further studies to identify potential modifiable factors in the perioperative care of neonates with CHD to improve neurodevelopmental outcomes.
在接受复杂心脏手术的婴儿中，高达50%会出现不良神经发育结局。我们试图确定接受复杂心脏手术的新生儿围手术期麻醉暴露与12个月龄时神经发育结局之间的关联，并确定磁共振成像（MRI）所确定的脑损伤的影响。
对接受复杂心脏手术的新生儿进行回顾性队列研究，这些新生儿术前和术后7天进行脑部MRI检查，并使用贝利婴幼儿发展量表第三版（Bayley-III）进行12个月龄时的神经发育测试。在生命的前12个月内确定挥发性麻醉剂（VAA）、苯二氮卓类药物和阿片类药物的剂量。
从97名婴儿的数据库中，59名符合纳入标准。平均±标准差综合标准分数如下：认知=102.1±13.3，语言=87.8±12.5，运动=89.6±14.1。经过向前逐步多变量分析，新的术后MRI损伤（P=0.039）和更高的VAA暴露（P=0.028）与较低的认知分数相关。ICU住院时间（与脑损伤无关）与Bayley-III所有类别的较低表现相关（P<0.02）。
在对多个相关协变量进行调整后，我们证明了VAA暴露、脑损伤、ICU住院时间与12个月龄时较低的神经发育结局分数之间存在关联。这些发现支持需要进一步研究，以确定患有先天性心脏病的新生儿围手术期护理中潜在的可改变因素，以改善神经发育结局。
