Cerebral and Somatic Oxygen Saturation in Neonates with Congenital Heart Disease before Surgery.

Mi Jin Kim,Jeong Jin Yu,Jung A Kim,Jae Suk Baek,Seul Gi Cha

doi:10.3390/jcm10112455

Abstract

Background: We investigated preoperative cerebral (ScO2) and abdominal (StO2) regional oxygen saturations according to cardiac diagnosis in neonates with critical CHD, their time trends, and the clinical and biochemical parameters associated with them. Methods: Thirty-seven neonates with a prenatal diagnosis of CHD were included. ScO2 and StO2 values were continuously evaluated using near-infrared spectroscopy. Measurements were obtained hourly before surgery. A linear mixed effects model was used to assess the effects of time and cardiac diagnosis on regional oxygenation and to explore the contributing factors. Results: Regional oxygenation differed according to cardiac diagnosis (p < 0.001). ScO2 was lowest in the patients with severe atrioventricular valvar regurgitation (AVVR) (48.1 ± 8.0%). StO2 tended to be lower than ScO2, and both worsened gradually during the period between birth and surgery. There was also a significant interaction between cardiac diagnosis and time. The factors related to ScO2 were hemoglobin and arterial saturation, whereas no factor was associated with StO2. Conclusions: Preoperative ScO2 and StO2 in critical CHD differed according to cardiac diagnosis. ScO2 in the patients with severe AVVR was very low, which may imply cerebral hypoxia. ScO2 gradually decreased, suggesting that the longer the time to surgery, the higher the risk of hypoxic brain injury.

Highlights

Neurobehavioral impairments are common in infants undergoing surgery for CHD, and they occur across a wide spectrum; cognition, motor, social interaction and behavior, language, inattention, and executive function [1,2,3,4,5,6,7,8,9,10]
Patients were classified according to their postnatal diagnosis: normal heart (n = 3), the great arteries (TGA) (n = 4), ductdependent systemic circulation (n = 10), duct-dependent pulmonary circulation (n = 13), severe atrioventricular valvar regurgitation (AVVR) (n = 2), total anomalous pulmonary vein return (TAPVR) or Truncus arteriosus (n = 5)
Chronic hypoxia, acidosis, poor nutrition, and inadequate cerebral perfusion due to hemodynamic instability are the possible factors contributing to brain injury

Summary

Introduction

Neurobehavioral impairments are common in infants undergoing surgery for CHD, and they occur across a wide spectrum; cognition, motor, social interaction and behavior, language, inattention, and executive function [1,2,3,4,5,6,7,8,9,10]. In patients with complex CHD, these abnormalities will be exacerbated by unstable hemodynamics before undergoing cardiac surgery. We investigated preoperative cerebral (ScO2 ) and abdominal (StO2 ) regional oxygen saturations according to cardiac diagnosis in neonates with critical CHD, their time trends, and the clinical and biochemical parameters associated with them. A linear mixed effects model was used to assess the effects of time and cardiac diagnosis on regional oxygenation and to explore the contributing factors. Results: Regional oxygenation differed according to cardiac diagnosis (p < 0.001). Conclusions: Preoperative ScO2 and StO2 in critical CHD differed according to cardiac diagnosis. ScO2 gradually decreased, suggesting that the longer the time to surgery, the higher the risk of hypoxic brain injury

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