BACKGROUND: The aim of this study is to determine the utility of non-invasive bedside neuromonitoring, including cerebral regional oxygen saturation (rSO2) measured by near-infrared spectroscopy and serum biomarkers, in identifying children at risk from adverse neurological outcome after heart surgery. METHODS: Prospective observational study including 39 consecutive children undergoing heart surgery with cardiopulmonary bypass (CPB) and normal neurologic exam prior to surgery. Cerebral rSO2 was measured at baseline (prior to surgery) and then continuously during surgery and for the first 16 h post-operatively. Neuromarkers [neuron-specific enolase (NSE), S100β, glial fibrillary acidic protein (GFAP), and brain-derived neurotrophic factor (BDNF)] were measured in serum at baseline, immediately after CPB and at 16 h post-operatively. Adverse neurological outcome was defined as an abnormal pediatric cerebral performance category (PCPC) scale score at 12 months after surgery. RESULTS: Sixteen children (41 %) had an abnormal PCPC scale score at the 12-month evaluation after surgery. In children with unfavorable neurological outcomes, mean cerebral rSO2 values were lower and the area-under-the-curve below a threshold of 40 and 20% below baseline were also increased. No significant differences were found in serum neuromarkers between groups at the time points that were assessed. CONCLUSIONS: Bedside determination of cerebral rSO2 may have some utility in identifying children at risk for adverse neurological outcome after heart surgery in children. Additional studies that are sufficiently powered to control for the many covariates in this patient population will be required to fully interrogate this important question. The role of serum neuromarkers in the immediate post-operative period do not appear to be helpful in this question, though more thorough interrogation of delayed periods may ultimately demonstrate some utility in answering this question.
BACKGROUND: The aim of this study is to determine the utility of non-invasive bedside neuromonitoring, including cerebral regional oxygen saturation (rSO2) measured by near-infrared spectroscopy and serum biomarkers, in identifying children at risk from adverse neurological outcome after heart surgery. METHODS: Prospective observational study including 39 consecutive children undergoing heart surgery with cardiopulmonary bypass (CPB) and normal neurologic exam prior to surgery. Cerebral rSO2 was measured at baseline (prior to surgery) and then continuously during surgery and for the first 16 h post-operatively. Neuromarkers [neuron-specific enolase (NSE), S100β, glial fibrillary acidic protein (GFAP), and brain-derived neurotrophic factor (BDNF)] were measured in serum at baseline, immediately after CPB and at 16 h post-operatively. Adverse neurological outcome was defined as an abnormal pediatric cerebral performance category (PCPC) scale score at 12 months after surgery. RESULTS: Sixteen children (41 %) had an abnormal PCPC scale score at the 12-month evaluation after surgery. In children with unfavorable neurological outcomes, mean cerebral rSO2 values were lower and the area-under-the-curve below a threshold of 40 and 20% below baseline were also increased. No significant differences were found in serum neuromarkers between groups at the time points that were assessed. CONCLUSIONS: Bedside determination of cerebral rSO2 may have some utility in identifying children at risk for adverse neurological outcome after heart surgery in children. Additional studies that are sufficiently powered to control for the many covariates in this patient population will be required to fully interrogate this important question. The role of serum neuromarkers in the immediate post-operative period do not appear to be helpful in this question, though more thorough interrogation of delayed periods may ultimately demonstrate some utility in answering this question.
Authors: Maurizio Arduini; Paolo Rosati; Leonardo Caforio; Lorenzo Guariglia; Graziano Clerici; Gian Carlo Di Renzo; Giovanni Scambia Journal: J Matern Fetal Neonatal Med Date: 2011-01-20
Authors: Jodi Chen; Robert A Zimmerman; Gail P Jarvik; Alex S Nord; Robert R Clancy; Gil Wernovsky; Lisa M Montenegro; Diane M Hartman; Susan C Nicolson; Thomas L Spray; J William Gaynor; Rebecca Ichord Journal: Ann Thorac Surg Date: 2009-09 Impact factor: 4.330
Authors: Hashim Abdul-Khaliq; Stephan Schubert; Gisela Stoltenburg-Didinger; Michael Huebler; Dirk Troitzsch; Anke Wehsack; Wolfgang Boettcher; Beat Schwaller; Michel Crausaz; Marco Celio; Matthias L Schröter; Ingolf E Blasig; Roland Hetzer; Peter E Lange Journal: Restor Neurol Neurosci Date: 2003 Impact factor: 2.406
Authors: Juan Villafañe; M Regina Lantin-Hermoso; Ami B Bhatt; James S Tweddell; Tal Geva; Meena Nathan; Martin J Elliott; Victoria L Vetter; Stephen M Paridon; Lazaros Kochilas; Kathy J Jenkins; Robert H Beekman; Gil Wernovsky; Jeffrey A Towbin Journal: J Am Coll Cardiol Date: 2014-08-05 Impact factor: 24.094
Authors: Anne M Plomgaard; Thomas Alderliesten; Topun Austin; Frank van Bel; Manon Benders; Olivier Claris; Eugene Dempsey; Monica Fumagalli; Christian Gluud; Cornelia Hagmann; Simon Hyttel-Sorensen; Petra Lemmers; Wim van Oeveren; Adelina Pellicer; Tue H Petersen; Gerhard Pichler; Per Winkel; Gorm Greisen Journal: PLoS One Date: 2017-03-22 Impact factor: 3.240
Authors: Johannes Menger; Maximilian Edlinger-Stanger; Martin Dworschak; Barbara Steinlechner Journal: Wien Klin Wochenschr Date: 2018-10-29 Impact factor: 1.704
Authors: I Ribera; A Ruiz; O Sánchez; E Eixarch; E Antolín; E Gómez-Montes; M Pérez-Cruz; M Cruz-Lemini; M Sanz-Cortés; S Arévalo; Q Ferrer; E Vázquez; L Vega; P Dolader; A Montoliu; H Boix; R V Simões; N Masoller; J Sánchez-de-Toledo; M Comas; J M Bartha; A Galindo; J M Martínez; L Gómez-Roig; F Crispi; O Gómez; E Carreras; L Cabero; E Gratacós; E Llurba Journal: BMC Pediatr Date: 2019-09-10 Impact factor: 2.125