Jennifer M Lynch1, Tiffany Ko2, David R Busch3, John J Newland4, Madeline E Winters4, Kobina Mensah-Brown4, Timothy W Boorady4, Rui Xiao5, Susan C Nicolson6, Lisa M Montenegro6, J William Gaynor7, Thomas L Spray7, Arjun G Yodh8, Maryam Y Naim9, Daniel J Licht4. 1. Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Penn. Electronic address: lynchj3@email.chop.edu. 2. Department of Bioengineering, University of Pennsylvania, Philadelphia, Pa; Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pa. 3. Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pa; Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pa. 4. Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pa. 5. Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pa. 6. Division of Cardiothoracic Anesthesia, The Children's Hospital of Philadelphia, Philadelphia, Pa. 7. Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pa. 8. Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pa. 9. Division of Cardiac Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pa.
Abstract
BACKGROUND: Hypoxic-ischemic white matter brain injury commonly occurs in neonates with critical congenital heart disease. Recent work has shown that longer time to surgery is associated with increased risk for this injury. In this study we investigated changes in perinatal cerebral hemodynamics during the transition from fetal to neonatal circulation to ascertain mechanisms that might underlie this risk. METHODS: Neonates with either transposition of the great arteries (TGA) or hypoplastic left heart syndrome (HLHS) were recruited for preoperative noninvasive optical monitoring of cerebral oxygen saturation, cerebral oxygen extraction fraction, and cerebral blood flow using diffuse optical spectroscopy and diffuse correlation spectroscopy, 2 noninvasive optical techniques. Measurements were acquired daily from day of consent until the morning of surgery. Temporal trends in these measured parameters during the preoperative period were assessed with a mixed effects model. RESULTS: Forty-eight neonates with TGA or HLHS were studied. Cerebral oxygen saturation was significantly and negatively correlated with time, and oxygen extraction fraction was significantly and positively correlated with time. Cerebral blood flow did not significantly change with time during the preoperative period. CONCLUSIONS: In neonates with TGA or HLHS, increasing cerebral oxygen extraction combined with an abnormal cerebral blood flow response during the time between birth and heart surgery leads to a progressive decrease in cerebral tissue oxygenation The results support and help explain the physiological basis for recent studies that show longer time to surgery increases the risk of acquiring white matter injury.
BACKGROUND:Hypoxic-ischemic white matter brain injury commonly occurs in neonates with critical congenital heart disease. Recent work has shown that longer time to surgery is associated with increased risk for this injury. In this study we investigated changes in perinatal cerebral hemodynamics during the transition from fetal to neonatal circulation to ascertain mechanisms that might underlie this risk. METHODS: Neonates with either transposition of the great arteries (TGA) or hypoplastic left heart syndrome (HLHS) were recruited for preoperative noninvasive optical monitoring of cerebral oxygen saturation, cerebral oxygen extraction fraction, and cerebral blood flow using diffuse optical spectroscopy and diffuse correlation spectroscopy, 2 noninvasive optical techniques. Measurements were acquired daily from day of consent until the morning of surgery. Temporal trends in these measured parameters during the preoperative period were assessed with a mixed effects model. RESULTS: Forty-eight neonates with TGA or HLHS were studied. Cerebral oxygen saturation was significantly and negatively correlated with time, and oxygen extraction fraction was significantly and positively correlated with time. Cerebral blood flow did not significantly change with time during the preoperative period. CONCLUSIONS: In neonates with TGA or HLHS, increasing cerebral oxygen extraction combined with an abnormal cerebral blood flow response during the time between birth and heart surgery leads to a progressive decrease in cerebral tissue oxygenation The results support and help explain the physiological basis for recent studies that show longer time to surgery increases the risk of acquiring white matter injury.
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