Nhu N. Tran is a clinical research nurse III, Department of Cardiothoracic Surgery, Children's Hospital Los Angeles, Los Angeles, California. Ram Kumar is an assistant professor of surgery, Keck School of Medicine, University of Southern California, Los Angeles, California. Felicia S. Hodge is a professor and Paul M. Macey is an associate professor, School of Nursing, University of California, Los Angeles.
Am J Crit Care. 2018 Sep;27(5):410-416. doi: 10.4037/ajcc2018672.
Congenital heart disease (CHD) is a leading birth defect in the United States, affecting about 40 000 neonates each year. Despite efforts to prevent developmental delays, many children with CHD have neurological deficits that last into adulthood, influencing employability, self-care, and quality of life.
To determine if neonates with CHD have impaired cerebral autoregulation and poorer neurodevelopmental outcomes compared with healthy controls.
A total of 44 full-term neonates, 28 with CHD and 16 without, were enrolled in the study. Inclusion criteria included confirmed diagnosis of CHD, stable hemodynamic status, and being no more than 12 days old. Exclusion criteria included intraventricular hemorrhage and intubation. Cerebral autoregulation was determined by measuring regional cerebral oxygenation during a postural change. The Einstein Neonatal Neurobehavioral Assessment Scale was used to measure overall neurodevelopmental outcomes (motor, visual, and auditory functions).
Of the 28 neonates with CHD, 8 had single-ventricle physiology. A χ analysis indicated no significant difference in impaired cerebral autoregulation between neonates with CHD and controls ( = .38). Neonates with CHD had lower regional cerebral oxygenation than did neonates without CHD ( < .001). Regression analyses with adjustments for cerebral autoregulation indicated that neonates with CHD had poorer total neurodevelopmental outcomes scores (β = 9.3; = .02) and motor scores (β = 7.6; = .04).
Preoperative neonates with CHD have poorer developmental outcomes and more hypoxemia than do controls.
先天性心脏病（CHD）是美国的一种主要出生缺陷，每年影响约 40000 名新生儿。尽管努力预防发育迟缓，但许多患有 CHD 的儿童仍存在持续到成年的神经发育缺陷，影响其就业能力、自我护理和生活质量。
确定与健康对照组相比，患有 CHD 的新生儿是否存在脑自动调节受损和神经发育不良的情况。
共有 44 名足月新生儿参与了这项研究，其中 28 名患有 CHD，16 名没有。纳入标准包括确诊为 CHD、血流动力学稳定以及年龄不超过 12 天。排除标准包括脑室出血和插管。通过测量体位变化期间的局部脑氧饱和度来确定脑自动调节。使用爱因斯坦新生儿神经行为评估量表测量整体神经发育结果（运动、视觉和听觉功能）。
在 28 名患有 CHD 的新生儿中，有 8 名患有单心室生理。卡方分析表明，CHD 新生儿和对照组之间的脑自动调节受损无显著差异（ =.38）。患有 CHD 的新生儿的局部脑氧饱和度低于没有 CHD 的新生儿（ <.001）。经过脑自动调节调整的回归分析表明，患有 CHD 的新生儿的总神经发育结果评分（β = 9.3； =.02）和运动评分（β = 7.6； =.04）更差。
术前患有 CHD 的新生儿的发育结果较差，且低氧血症的发生率高于对照组。
