Institute for the Developing Mind, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California, United States of America.
Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America.
PLoS One. 2021 May 10;16(5):e0251255. doi: 10.1371/journal.pone.0251255. eCollection 2021.
Infants with Congenital Heart Disease (CHD) are at risk for developmental delays, though the mechanisms of brain injury that impair development are unknown. Potential causes could include cerebral hypoxia and cerebrovascular instability. We hypothesized that we would detect significantly reduced cerebral oxygen saturation and greater cerebrovascular instability in CHD infants compared to the healthy controls.
We performed a secondary analysis on a sample of 43 term infants (28 CHD, 15 healthy controls) that assessed prospectively in temporal cross-section before or at 12 days of age. CHD infants were assessed prior to open-heart surgery. Cerebral oxygen saturation levels were estimated using Near-Infrared Spectroscopy, and cerebrovascular stability was assessed with the response of cerebral oxygen saturation after a postural change (supine to sitting).
Cerebral oxygen saturation was 9 points lower in CHD than control infants in both postures (β = -9.3; 95%CI = -17.68, -1.00; p = 0.028), even after controlling for differences in peripheral oxygen saturation. Cerebrovascular stability was significantly impaired in CHD compared to healthy infants (β = -2.4; 95%CI = -4.12, -.61; p = 0.008), and in CHD infants with single ventricle compared with biventricular defects (β = -1.5; 95%CI = -2.95, -0.05; p = 0.04).
CHD infants had cerebral hypoxia and decreased cerebral oxygen saturation values following a postural change, suggesting cerebrovascular instability. Future longitudinal studies should assess the associations of cerebral hypoxia and cerebrovascular instability with long-term neurodevelopmental outcomes in CHD infants.
患有先天性心脏病（CHD）的婴儿存在发育迟缓的风险，但其导致发育受损的脑损伤机制尚不清楚。潜在的原因可能包括脑缺氧和脑血管不稳定。我们假设与健康对照组相比，CHD 婴儿的脑氧饱和度明显降低，脑血管不稳定程度更大。
我们对 43 名足月婴儿（28 名 CHD，15 名健康对照）进行了二次分析，这些婴儿在出生前或 12 天内进行了前瞻性时间交叉评估。CHD 婴儿在心脏直视手术前接受评估。使用近红外光谱法估计脑氧饱和度水平，通过体位变化（仰卧位变为坐位）后脑氧饱和度的反应评估脑血管稳定性。
在两种体位下，CHD 婴儿的脑氧饱和度比对照组婴儿低 9 个点（β=-9.3；95%CI=-17.68，-1.00；p=0.028），即使在控制外周氧饱和度差异后也是如此。与健康婴儿相比，CHD 婴儿的脑血管稳定性明显受损（β=-2.4；95%CI=-4.12，-.61；p=0.008），且单心室 CHD 婴儿比双心室缺陷婴儿受损更严重（β=-1.5；95%CI=-2.95，-0.05；p=0.04）。
CHD 婴儿在体位改变后出现脑缺氧和脑氧饱和度降低，表明脑血管不稳定。未来的纵向研究应评估脑缺氧和脑血管不稳定与 CHD 婴儿长期神经发育结局的关联。
