Abstract 17205: The Association of Cerebrovascular Autoregulation With Neurodevelopmental Delays Between Infants With and Without Congenital Heart Disease

Abstract

Background: Children with Congenital Heart Disease ( CHD ) are 5 times more likely to develop neurodevelopmental impairment lasting into adulthood compared to their peers. One theory is that hypoxemia associated with CHD contributes to impaired cerebrovascular autoregulation ( CA ), which in turn may contribute to neurological injuries and impaired neurodevelopmental outcome ( NDO ) in CHD. This study examined the association of CA and NDO between CHD and healthy infants. Hypothesis: Impaired CA will be associated with poorer NDO in CHD infants through 9-month development. Methods: A prospective, longitudinal study was performed at 3, 6, & 9-month time points. CA was indexed by calculating the difference between 2-minute averaged supine and sitting cerebral oxygenation (rcSO 2 ) measured by near-infrared spectroscopy for 3 consecutive tilts (0-90°), resulting in change scores. The Bayley Scales of Infant and Toddler Development III measured NDO. Multiple linear regressions quantified the group-by-CA interaction on NDO at each age. Results: We enrolled 35 CHD and 26 healthy control ( HC ) infants. 3 months: As CA worsened (change score in rcSO 2 increased by 1-unit), cognitive compositive scores decreased by 2.6% in the CHD group compared to the HC during the 3 rd postural change (P=0.003). 6 months: As CA worsened, the language composite scores decreased by 3.7% in the CHD group at compared to the HC for the 1 st postural change (P=0.041). 9 months: As CA worsened, the cognitive composite scores decreased by 2.7% in the CHD group compared to the HC during the 3 rd postural change (P=0.046). See Table 1. Conclusion: We found poorer CA to be significantly associated with worse NDO in CHD infants. These initial results demonstrate the persistence of impaired CA even after surgical repair of CHD, which may be a mechanism of brain injury. Future directions include larger studies and targeted interventions to improve CA to reduce developmental delays in CHD children.