Dataset Information

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

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.

SUBMITTER: Kim MJ

PROVIDER: S-EPMC8199521 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Background Abnormal macrostructural development of the cerebral cortex has been associated with hypoxia in infants with congenital heart disease ( CHD ). Animal studies have suggested that hypoxia results in cortical dysmaturation at the cellular level. New magnetic resonance imaging techniques offer the potential to investigate the relationship between cerebral oxygen delivery and cortical microstructural development in newborn infants with CHD . Methods and Results We measured cortical macrostructural and microstructural properties in 48 newborn infants with serious or critical CHD and 48 age-matched healthy controls. Cortical volume and gyrification index were calculated from high-resolution structural magnetic resonance imaging. Neurite density and orientation dispersion indices were modeled using high-angular-resolution diffusion magnetic resonance imaging. Cerebral oxygen delivery was estimated in infants with CHD using phase contrast magnetic resonance imaging and preductal pulse oximetry. We used gray matter-based spatial statistics to examine voxel-wise group differences in cortical microstructure. Microstructural development of the cortex was abnormal in 48 infants with CHD , with regions of increased fractional anisotropy and reduced orientation dispersion index compared with 48 healthy controls, correcting for gestational age at birth and scan (family-wise error corrected for multiple comparisons at P<0.05). Regions of reduced cortical orientation dispersion index in infants with CHD were related to impaired cerebral oxygen delivery ( R2=0.637; n=39). Cortical orientation dispersion index was associated with the gyrification index ( R2=0.589; P<0.001; n=48). Conclusions This study suggests that the primary component of cerebral cortex dysmaturation in CHD is impaired dendritic arborization, which may underlie abnormal macrostructural findings reported in this population, and that the degree of impairment is related to reduced cerebral oxygen delivery.