Maria Feldmann1,2, Cornelia Hagmann2,3, Linda de Vries4, Vera Disselhoff1,2, Kuberan Pushparajah5,6, Thushiha Logeswaran7, Nicolaas J G Jansen8,9, Johannes M P J Breur10, Walter Knirsch11, Manon Benders4,12, Serena Counsell6, Bettina Reich13, Beatrice Latal14,15. 1. Child Development Centre, University Children's Hospital Zurich, Zurich, Switzerland. 2. Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland. 3. Department of Neonatology and Pediatric Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland. 4. Utrecht Brain Center, UMC Utrecht, Utrecht University, Utrecht, The Netherlands. 5. Pediatric Cardiology Department, Evelina Children's Hospital London, London, UK. 6. Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK. 7. Pediatric Heart Center, University Hospital Giessen, Justus-Liebig-University Giessen, Giessen, Germany. 8. Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands. 9. Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands. 10. Department of Pediatric Cardiology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands. 11. Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland. 12. Department of Neonatology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands. 13. Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Munich, Germany. 14. Child Development Centre, University Children's Hospital Zurich, Zurich, Switzerland. bea.latal@kispi.uzh.ch. 15. Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland. bea.latal@kispi.uzh.ch.
Abstract
BACKGROUND: Brain injury and neurodevelopmental impairment remain a concern in children with complex congenital heart disease (CHD). A practice guideline on neuromonitoring, neuroimaging, and neurodevelopmental follow-up in CHD patients undergoing cardiopulmonary bypass surgery is lacking. The aim of this survey was to systematically evaluate the current practice in centers across Europe. METHODS: An online-based structured survey was sent to pediatric cardiac surgical centers across Europe between April 2019 and June 2020. Results were summarized by descriptive statistics. RESULTS: Valid responses were received by 25 European centers, of which 23 completed the questionnaire to the last page. Near-infrared spectroscopy was the most commonly used neuromonitoring modality used in 64, 80, and 72% preoperatively, intraoperatively, and postoperatively, respectively. Neuroimaging was most commonly performed by means of cranial ultrasound in 96 and 84% preoperatively and postoperatively, respectively. Magnetic resonance imaging was obtained in 72 and 44% preoperatively and postoperatively, respectively, but was predominantly reserved for clinically symptomatic patients (preoperatively 67%, postoperatively 64%). Neurodevelopmental follow-up was implemented in 40% of centers and planned in 24%. CONCLUSIONS: Heterogeneity in perioperative neuromonitoring and neuroimaging practice in CHD in centers across Europe is large. The need for neurodevelopmental follow-up has been recognized. A clear practice guideline is urgently needed. IMPACT: There is large heterogeneity in neuromonitoring, neuroimaging, and neurodevelopmental follow-up practices among European centers caring for neonates with complex congenital heart disease. This study provides a systematic evaluation of the current neuromonitoring, neuroimaging, and neurodevelopmental follow-up practice in Europe. The results of this survey may serve as the basis for developing a clear practice guideline that could help to early detect and prevent neurological and neurodevelopmental sequelae in neonates with complex congenital heart disease.
BACKGROUND: Brain injury and neurodevelopmental impairment remain a concern in children with complex congenital heart disease (CHD). A practice guideline on neuromonitoring, neuroimaging, and neurodevelopmental follow-up in CHD patients undergoing cardiopulmonary bypass surgery is lacking. The aim of this survey was to systematically evaluate the current practice in centers across Europe. METHODS: An online-based structured survey was sent to pediatric cardiac surgical centers across Europe between April 2019 and June 2020. Results were summarized by descriptive statistics. RESULTS: Valid responses were received by 25 European centers, of which 23 completed the questionnaire to the last page. Near-infrared spectroscopy was the most commonly used neuromonitoring modality used in 64, 80, and 72% preoperatively, intraoperatively, and postoperatively, respectively. Neuroimaging was most commonly performed by means of cranial ultrasound in 96 and 84% preoperatively and postoperatively, respectively. Magnetic resonance imaging was obtained in 72 and 44% preoperatively and postoperatively, respectively, but was predominantly reserved for clinically symptomatic patients (preoperatively 67%, postoperatively 64%). Neurodevelopmental follow-up was implemented in 40% of centers and planned in 24%. CONCLUSIONS: Heterogeneity in perioperative neuromonitoring and neuroimaging practice in CHD in centers across Europe is large. The need for neurodevelopmental follow-up has been recognized. A clear practice guideline is urgently needed. IMPACT: There is large heterogeneity in neuromonitoring, neuroimaging, and neurodevelopmental follow-up practices among European centers caring for neonates with complex congenital heart disease. This study provides a systematic evaluation of the current neuromonitoring, neuroimaging, and neurodevelopmental follow-up practice in Europe. The results of this survey may serve as the basis for developing a clear practice guideline that could help to early detect and prevent neurological and neurodevelopmental sequelae in neonates with complex congenital heart disease.
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