Division of Pediatric Critical Care, University of Virginia School of Medicine, Charlottesville, VA, USA.
Division of Pediatric Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Pediatr Res. 2021 Oct;90(4):815-818. doi: 10.1038/s41390-020-01171-1. Epub 2020 Sep 23.
Reduced cerebral regional oxygen saturation (crSO) variability in neonates, as measured by near-infrared spectroscopy, following cardiac surgery with deep hypothermic circulatory arrest (DHCA) is associated with poor neurodevelopmental outcomes. We sought to evaluate the variability of crSO in a cohort of neonates following cardiac surgery with brief or no exposure to DHCA.
Variability of averaged 1-min crSO values was calculated for the first 48 h following cardiac surgery in consecutive neonates over a 30-month period. Neonates requiring aortic arch repair underwent antegrade cerebral perfusion with either brief or no exposure to DHCA.
There were 115 neonates included in the study. Reduced crSO variability was observed in neonates with aortic arch obstruction (p = 0.02) and non-survivors (p = 0.02). Post hoc analysis demonstrated that the reduction in crSO variability was not as marked as in previously studied neonates with aortic arch obstruction who received DHCA alone (p < 0.001).
Neonates with aortic arch obstruction have reduced crSO variability following cardiac surgery. The reduction in crSO variability observed in aortic arch obstruction is likely influenced by a number of factors, including perioperative perfusion technique. The impact of interventions on crSO variability and resultant influence on neurodevelopmental outcomes requires further study.
Neonates with aortic arch obstruction have reduced crSO variability following cardiac surgery, which has been associated with poor neurodevelopmental outcomes, and is likely influenced by a number of factors, including perioperative perfusion technique. The contribution of perioperative perfusion technique to crSO variability following neonatal cardiac surgery is significant. Monitoring of crSO variability may provide insights into the adequacy of cerebral perfusion in neonates following cardiac surgery.
心脏手术后使用近红外光谱测量，脑区域性氧饱和度（crSO）变异性降低与神经发育不良结局相关。我们试图评估心脏手术后短暂或无深低温停循环（DHCA）暴露的新生儿 crSO 变异性。
在 30 个月的时间内，对连续接受心脏手术的新生儿在手术后的前 48 小时内，计算平均 1 分钟 crSO 值的变异性。需要主动脉弓修复的新生儿进行顺行性脑灌注，有短暂或无 DHCA 暴露。
本研究共纳入 115 例新生儿。主动脉弓阻塞（p=0.02）和未存活的新生儿 crSO 变异性降低（p=0.02）。事后分析表明，crSO 变异性的降低不如单独接受 DHCA 的主动脉弓阻塞新生儿明显（p<0.001）。
心脏手术后主动脉弓阻塞的新生儿 crSO 变异性降低。主动脉弓阻塞中观察到的 crSO 变异性降低可能受到多种因素的影响，包括围手术期灌注技术。干预对 crSO 变异性的影响及其对神经发育结局的影响需要进一步研究。
心脏手术后主动脉弓阻塞的新生儿 crSO 变异性降低，与神经发育不良结局相关，可能受到多种因素的影响，包括围手术期灌注技术。围手术期灌注技术对新生儿心脏手术后 crSO 变异性的影响显著。监测 crSO 变异性可能为心脏手术后新生儿脑灌注是否充足提供见解。
