先天性心脏病患儿手术后脑损伤与神经发育结局
Brain injury and neurodevelopmental outcomes in children undergoing surgery for congenital heart disease.
作者信息
Reitz Justus G, Zurakowski David, Kuhn Viktoria A, Murnick Johnathan, Donofrio Mary T, d'Udekem Yves, Licht Daniel, Kosiorek Agnieszka, Limperopoulos Catherine, Axt-Fliedner Roland, Yerebakan Can, Carpenter Jessica L
机构信息
Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, University Hospital Giessen and Marburg, Justus-Liebig University Giessen, Giessen, Germany.
Departments of Surgery and Anesthesiology, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
出版信息
JTCVS Open. 2023 Dec 4;17:229-247. doi: 10.1016/j.xjon.2023.11.018. eCollection 2024 Feb.
OBJECTIVES
Brain injury is commonly seen on magnetic resonance imaging in infants with complex congenital heart disease. The impact of perioperative brain injury on neurodevelopmental outcomes is not well understood. We evaluate the association of brain injury and other markers on neurodevelopmental outcomes in patients undergoing surgery for congenital heart surgery during infancy.
METHODS
Term newborns with infant cardiac surgery performed between 2008 and 2019 at a single tertiary center, and both preoperative and postoperative brain magnetic resonance imaging were included. Those with underlying genetic conditions were excluded. Brain injury was characterized using an magnetic resonance imaging scoring system. Neurodevelopmental outcomes were assigned using the Pediatric Stroke Outcome Measure and Glasgow Outcome Scale Extended. Independent risk factors for poor neurodevelopmental outcomes were determined by multivariable Cox regression.
RESULTS
A total of 122 patients were included. New or progressive postoperative brain injury was noted in 69 patients (57%). A total of 101 patients (83%) had at least 1 neurodevelopmental assessment (median age 36 months) with an early assessment (5-24 months) performed in 95 children. Multivariable Cox regression analysis of early neurodevelopmental outcomes identified new stroke on postoperative magnetic resonance imaging to be an independent predictor of poor neurodevelopmental outcome. Postoperative peak lactate was an independent predictor of poor outcome assessed by the Pediatric Stroke Outcome Measure and Glasgow Outcome Scale Extended.
CONCLUSIONS
Our study reveals that evidence of new stroke on magnetic resonance imaging after infant congenital heart surgery is a predictor of poor neurodevelopmental outcomes in early childhood. Postoperative lactic acidosis is associated with poor neurodevelopmental outcome and may be a surrogate biomarker for ischemic brain injury.
目的
在患有复杂先天性心脏病的婴儿中，磁共振成像上常见脑损伤。围手术期脑损伤对神经发育结局的影响尚未完全明确。我们评估脑损伤及其他标志物与婴儿期接受先天性心脏病手术患者神经发育结局之间的关联。
方法
纳入2008年至2019年在单一三级中心接受婴儿心脏手术的足月儿，术前行脑磁共振成像，术后也进行脑磁共振成像。排除有潜在遗传疾病的患者。使用磁共振成像评分系统对脑损伤进行特征描述。使用儿童卒中结局测量量表和扩展格拉斯哥结局量表对神经发育结局进行评估。通过多变量Cox回归确定神经发育结局不良的独立危险因素。
结果
共纳入122例患者。69例患者（57%）术后出现新的或进展性脑损伤。共有101例患者（83%）至少进行了1次神经发育评估（中位年龄36个月），其中95例儿童进行了早期评估（5 - 24个月）。对早期神经发育结局的多变量Cox回归分析确定，术后磁共振成像上新发卒中是神经发育结局不良的独立预测因素。术后乳酸峰值是儿童卒中结局测量量表和扩展格拉斯哥结局量表评估结局不良的独立预测因素。
结论
我们的研究表明，婴儿先天性心脏病手术后磁共振成像上新发卒中的证据是儿童早期神经发育结局不良的预测因素。术后乳酸性酸中毒与神经发育结局不良相关，可能是缺血性脑损伤的替代生物标志物。
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