OBJECTIVE: To monitor the pattern of cerebral oxygen saturation (rSat), by use of NIRS, in term infants before, during and after the arterial switch operation and to evaluate its relation to neurodevelopmental outcome. METHODS: In 20 neonates without pre-existing brain damage hemodynamics and arterial oxygen saturation (AO2-Sat) were monitored simultaneously with rSat and amplitude-integrated EEG (aEEG) from 4 h to 12 h before up to 36 h after cardiopulmonary bypass (CPB) and short duration of cardiac arrest during deep hypothermia (DHCA). The Bayleys developmental scale was performed at 30 months. RESULTS: Before surgery rSat was <50% in 16 patients. During CPB rSat increased to normal values, with a sharp decrease during brief CA (median 6.5 min). Post-CPB rSat showed a transient decrease (30-45%) despite normal PaO2 with sustained normalization after 6-26 h. Recovery time of the rSat seemed longer when pre-operative rSat was below 35%, and for lower minimum nasopharyngeal temperature and longer duration of CPB and of DHCA. Recovery time of the aEEG varied and did not correlate with normalization of rSat. Neurodevelopmental outcome was normal in all but two patients. Patients with lower pre-operative rSat (<35%) tended to have lower DQ (developmental quotient) scores at 30-36 months. (median: mental 102 and motor 101 (range 58-125) compared with mental 100 and motor 110 (range 83-125)) CONCLUSION: Despite prompt normalization of circulation and oxygenation after surgery, recovery of rSat of the brain took 6-26 h, probably because of higher energy demand after CPB. Pre-operative cerebral oxygenation may be underestimated as a possible cause of adverse post-operative outcome.
OBJECTIVE: To monitor the pattern of cerebral oxygen saturation (rSat), by use of NIRS, in term infants before, during and after the arterial switch operation and to evaluate its relation to neurodevelopmental outcome. METHODS: In 20 neonates without pre-existing brain damage hemodynamics and arterial oxygen saturation (AO2-Sat) were monitored simultaneously with rSat and amplitude-integrated EEG (aEEG) from 4 h to 12 h before up to 36 h after cardiopulmonary bypass (CPB) and short duration of cardiac arrest during deep hypothermia (DHCA). The Bayleys developmental scale was performed at 30 months. RESULTS: Before surgery rSat was <50% in 16 patients. During CPB rSat increased to normal values, with a sharp decrease during brief CA (median 6.5 min). Post-CPB rSat showed a transient decrease (30-45%) despite normal PaO2 with sustained normalization after 6-26 h. Recovery time of the rSat seemed longer when pre-operative rSat was below 35%, and for lower minimum nasopharyngeal temperature and longer duration of CPB and of DHCA. Recovery time of the aEEG varied and did not correlate with normalization of rSat. Neurodevelopmental outcome was normal in all but two patients. Patients with lower pre-operative rSat (<35%) tended to have lower DQ (developmental quotient) scores at 30-36 months. (median: mental 102 and motor 101 (range 58-125) compared with mental 100 and motor 110 (range 83-125)) CONCLUSION: Despite prompt normalization of circulation and oxygenation after surgery, recovery of rSat of the brain took 6-26 h, probably because of higher energy demand after CPB. Pre-operative cerebral oxygenation may be underestimated as a possible cause of adverse post-operative outcome.
Authors: R R Clancy; S A McGaurn; J E Goin; D G Hirtz; W I Norwood; J W Gaynor; M L Jacobs; G Wernovsky; W T Mahle; J D Murphy; S C Nicolson; J M Steven; T L Spray Journal: Pediatrics Date: 2001-07 Impact factor: 7.124
Authors: Mona C Toet; Wil van der Meij; Linda S de Vries; Cuno S P M Uiterwaal; Kees C van Huffelen Journal: Pediatrics Date: 2002-05 Impact factor: 7.124
Authors: F Nomura; H Naruse; A duPlessis; T Hiramatsu; J Forbess; D Holtzman; J J Volpe; R Jonas; M Tsuji Journal: Pediatr Res Date: 1996-12 Impact factor: 3.756
Authors: Robert R Clancy; Susan A McGaurn; Gil Wernovsky; J William Gaynor; Thomas L Spray; William I Norwood; Marshall L Jacobs; James E Goin Journal: Pediatrics Date: 2003-03 Impact factor: 7.124
Authors: Mathieu Dehaes; Henry H Cheng; Erin M Buckley; Pei-Yi Lin; Silvina Ferradal; Kathryn Williams; Rutvi Vyas; Katherine Hagan; Daniel Wigmore; Erica McDavitt; Janet S Soul; Maria Angela Franceschini; Jane W Newburger; P Ellen Grant Journal: Biomed Opt Express Date: 2015-11-09 Impact factor: 3.732
Authors: Julia K Gunn; John Beca; Rodney W Hunt; Monika Olischar; Lara S Shekerdemian Journal: Intensive Care Med Date: 2012-06-01 Impact factor: 17.440
Authors: Felix Neunhoeffer; Michael Hofbeck; Christian Schlensak; Martin Ulrich Schuhmann; Jörg Michel Journal: Pediatr Cardiol Date: 2018-08-25 Impact factor: 1.655