Division of Neonatal-Perinatal Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA.
Division of Neonatology, University of Virginia School of Medicine, Charlottesville, VA, USA.
Pediatr Cardiol. 2023 Oct;44(7):1560-1565. doi: 10.1007/s00246-023-03239-1. Epub 2023 Jul 19.
Near-infrared spectroscopy is routinely used in the monitoring of cerebral regional oxygen saturation (crSO) in neonates following congenital heart surgery. Decreased postoperative crSO variability in these patients is associated with worse clinical outcomes, including neurodevelopmental outcomes. We sought to explore changes in crSO variability between the preoperative and postoperative periods and associations with short-term clinical outcomes in neonates undergoing cardiac surgery. We performed a prospective cohort study of neonates undergoing cardiac surgery with cardiopulmonary bypass between November 2019 and May 2021. We calculated crSO variability using averaged 1 min of crSO values for a minimum of 12 h before, and the first 48 h following surgery. 37 neonates (median age at start of monitoring 4 days (interquartile range 2-5 days)) were included in our study. We observed a 30% decrease in crSO variability between the preoperative and postoperative monitoring periods (p < 0.001). Preoperative crSO variability increased by 9% (p = 0.009) for each additional postnatal day. There were no associations between the degree of decrease in crSO variability postoperatively and class of cardiac lesion (e.g., aortic arch obstruction, single ventricle physiology) or short-term postoperative clinical outcomes. There was a significant decrease in postoperative crSO variability following neonatal cardiac surgery as compared to the preoperative period, likely influenced by several factors. The impact of interventions on crSO variability and resultant influence on long-term outcomes, such as neurodevelopmental outcomes, requires further exploration.
近红外光谱技术常用于监测先天性心脏病手术后新生儿的脑区域性氧饱和度 (crSO)。这些患者术后 crSO 变异性降低与更差的临床结局相关，包括神经发育结局。我们旨在探讨心脏手术后新生儿 crSO 变异性在术前和术后的变化及其与短期临床结局的关系。我们对 2019 年 11 月至 2021 年 5 月期间行体外循环心脏手术的新生儿进行了前瞻性队列研究。我们使用术前至少 12 小时和术后第 1 至 48 小时的 crSO 值的平均值来计算 crSO 变异性。共有 37 名新生儿（开始监测时的中位年龄为 4 天（四分位距 2-5 天））纳入本研究。我们观察到 crSO 变异性在术前和术后监测期间下降了 30%（p<0.001）。每增加一天的新生儿龄，术前 crSO 变异性增加 9%（p=0.009）。术后 crSO 变异性的降低程度与心脏病变的类型（如主动脉弓阻塞、单心室生理学）或短期术后临床结局之间没有关联。与术前相比，新生儿心脏手术后 crSO 变异性显著降低，这可能受到多种因素的影响。干预措施对 crSO 变异性的影响以及对长期结局（如神经发育结局）的影响需要进一步探索。
