Spaeder Michael C, Klugman Darren, Skurow-Todd Kami, Glass Penny, Jonas Richard A, Donofrio Mary T
1Division of Pediatric Critical Care, University of Virginia School of Medicine, Charlottesville, VA. 2Divisions of Critical Care Medicine and Cardiology, Children's National Health System, Washington, DC. 3Division of Cardiology, Children's National Health System, Washington, DC. 4Division of Psychology and Behavioral Health, Children's National Health System, Washington, DC. 5Division of Cardiac Surgery, Children's National Health System, Washington, DC.
Pediatr Crit Care Med. 2017 Mar;18(3):213-218. doi: 10.1097/PCC.0000000000001056.
To evaluate the value of perioperative cerebral near-infrared spectroscopy monitoring using variability analysis in the prediction of neurodevelopmental outcomes in neonates undergoing surgery for congenital heart disease.
Retrospective cohort study.
Urban, academic, tertiary-care children's hospital.
Neonates undergoing surgery with cardiopulmonary bypass for congenital heart disease.
Perioperative monitoring of continuous cerebral tissue oxygenation index by near-infrared spectroscopy and subsequent neurodevelopmental testing at 6, 15, and 21 months of age.
We developed a new measure, cerebral tissue oxygenation index variability, using the root mean of successive squared differences of averaged 1-minute cerebral tissue oxygenation index values for both the intraoperative and first 24-hours postoperative phases of monitoring. There were 62 neonates who underwent cerebral tissue oxygenation index monitoring during surgery for congenital heart disease and 44 underwent subsequent neurodevelopmental testing (12 did not survive until testing and six were lost to follow-up). Among the 44 monitored patients who underwent neurodevelopmental testing, 20 (45%) had abnormal neurodevelopmental indices. Patients with abnormal neurodevelopmental indices had lower postoperative cerebral tissue oxygenation index variability when compared with patients with normal indices (p = 0.01). Adjusting for class of congenital heart disease and duration of deep hypothermic circulatory arrest, lower postoperative cerebral tissue oxygenation index variability was associated with poor neurodevelopmental outcome (p = 0.02).
We found reduced postoperative cerebral tissue oxygenation index variability in neonatal survivors of congenital heart disease surgery with poor neurodevelopmental outcomes. We hypothesize that reduced cerebral tissue oxygenation index variability may be a surrogate for impaired cerebral metabolic autoregulation in the immediate postoperative period. Further research is needed to investigate clinical implications of this finding and opportunities for using this measure to drive therapeutic interventions.
评估围手术期使用变异性分析的脑近红外光谱监测在预测先天性心脏病手术新生儿神经发育结局中的价值。
回顾性队列研究。
城市学术三级儿童医院。
接受先天性心脏病体外循环手术的新生儿。
通过近红外光谱对脑组织氧合指数进行围手术期连续监测，并在6、15和21月龄时进行后续神经发育测试。
我们开发了一种新指标，即脑组织氧合指数变异性，它采用术中及术后首个24小时监测阶段平均1分钟脑组织氧合指数值连续平方差的均方根。有62例新生儿在先天性心脏病手术期间接受了脑组织氧合指数监测，44例接受了后续神经发育测试（12例未存活至测试阶段，6例失访）。在44例接受神经发育测试的监测患者中，20例（45%）神经发育指标异常。与神经发育指标正常的患者相比，神经发育指标异常的患者术后脑组织氧合指数变异性更低（p = 0.01）。在调整先天性心脏病类型和深低温循环停搏持续时间后，术后脑组织氧合指数变异性较低与不良神经发育结局相关（p = 0.02）。
我们发现先天性心脏病手术存活新生儿中，神经发育结局不良者术后脑组织氧合指数变异性降低。我们推测，术后早期脑组织氧合指数变异性降低可能是脑代谢自动调节受损的替代指标。需要进一步研究以探讨这一发现的临床意义以及利用该指标推动治疗干预的机会。
