Preoperative Clinical Neurological Assessment in New-borns with Critical Congenital Heart Disease

Abstract

Objectives: To evaluate preoperative neurological abnormalities in term newborns with critical congenital heart disease (CHD) and to study relationships among the neurological abnormalities, CHD type and clinical characteristics in the group. Methods: Term newborns with critical CHD without genetic disorders were retrospectively studied. Neurological abnormalities were grouped according to Amiel-Tison neurological assessment (ATNA). CHD was categorized into five subgroups according to the physiological presentation. Results: In the period observed 190 newborns with critical CHD were admitted. Of 134 who met the inclusion criteria, ATNA was optimal in 64%; in 28.5% it was mildly, in 6.5% moderately, and in 1% severely abnormal. The difference in the frequency of abnormal ATNA between the five CHD subgroups was not statistically significant (p = 0.098). A weak association was identified between CHD subgroups and an abnormal ATNA (contingency coefficient 0.246). Newborns with abnormal ATNA had more often SpO2 < 92% (p = 0.028) and abnormal results of cerebral ultrasound (p = 0.001). Conclusion: This study establishes the value of Amiel-Tison standardized neurological examination in assessing the risk of neurodevelopmental disorders among newborns with CHD. We found preoperative neurological abnormalities in one-third of newborns with CHD, and the grade of abnormalities was generally mild or moderate. Newborns with an abnormal ATNA more frequently presented an oxygen saturation < 92% and abnormal results on the cranial ultrasound.