Abstract 14419: Cerebrovascular Stability Index is Associated With Motor Development Scores in 6-month Infants With Congenital Heart Disease

Abstract

Introduction: Infants with congenital heart disease ( CHD ) have an increased risk for poorer neurodevelopmental outcomes ( NDO ) compared to healthy infants. Impaired cerebrovascular autoregulation ( CA ) may contribute to neurologic abnormalities in CHD infants. This study’s purpose is to assess cerebrovascular stability index ( CSI ), as a surrogate for CA, and its associations with NDO in infants with CHD compared to healthy control infants at 3 early-age timepoints. Hypothesis: We hypothesized that CHD infants who have poorer CSI will have significantly poorer neurodevelopmental outcomes than infants with better CSI. Methods: We conducted a prospective, longitudinal study in CHD infants and healthy controls ( HC ). We measured CSI and NDO at 3 ages (neonatal, 3-month, and 6-month). We performed 3 tilts while measuring cerebral oxygenation via near-infrared spectroscopy. CSI was determined by subtracting the average 2-minute sitting cerebral oxygenation from the 2-minute supine value for each tilt, then averaging the 3 tilt values for each age. The Einstein Neonatal Neurobehavioral Assessment Scale ( ENNAS ) measured neonatal NDO, while the Bayley-3 evaluated the 3 and 6-month NDO. Results: We assessed a total of 28 CHD and 40 HC infants. CHD infants had significantly lower ENNAS scores as neonates (68 CHD vs 83 HC, p<0.001), and at 6-months had lower cognitive (94 CHD vs 100 HC, p=0.04), and motor (86 CHD vs 98 HC, p<0.001) composite scores compared with the HC. However, the other domains did not significantly differ between groups. Linear regression analyses showed that motor development scores in the CHD group improved as CSI improved when adjusted for sex and ethnicity (β=3.64, SE=1.47, p=0.02). CSI did not significantly associate with the cognitive score or NDO for the other ages. Conclusion: We found better CSI significantly associated with higher motor development scores in 6-month old CHD infants, suggesting that impaired CSI may underlie abnormalities of motor development in CHD. Future studies are needed to better understand the mechanism of interaction between CSI and motor development.