Cerebral oxygen delivery is reduced in newborns with congenital heart disease

Lim, Jessie Mei; Kingdom, Theodore; Saini, Brahmdeep S.; Chau, Vann; Post, Martin; Blaser, Susan; Macgowan, Christopher K.; Miller, Steven P.; Seed, Mike

doi:10.1016/j.jtcvs.2016.05.027

Cited by 69 publications

(79 citation statements)

References 38 publications

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“…An accumulating body of literature has brought to light the negative impact of impairments in oxygen and substrate delivery on the growth and maturation of the vulnerable and rapidly developing brains of infants with complex CHD. [8][9][10][11] In addition, these infants are at an increased risk for brain injuries during the perioperative period. 12 In fact, the prevalence of brain abnormalities in infants with complex CHD is estimated to range from 41% to 67%.…”

mentioning

confidence: 99%

Structural brain abnormalities in adolescents and young adults with congenital heart defect: a systematic review

Bolduc

Lambert

Ganeshamoorthy

et al. 2018

Develop Med Child Neuro

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mentioning

confidence: 99%

Structural brain abnormalities in adolescents and young adults with congenital heart defect: a systematic review

Bolduc

Lambert

Ganeshamoorthy

et al. 2018

Develop Med Child Neuro

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“…Swallowing is a highly dynamic process that is influenced not only by bolus attributes and anatomic integrity, but also by neurologic, muscular, respiratory, and gastrointestinal function. [23][24][25][26] Altered prenatal circulatory patterns, and post-surgical stresses of in parallel circulation, cyanosis, and ventricular volume load can have deleterious effects on these systems [27][28][29][30][31][32][33][34] and may contribute to the observed swallowing deficits.…”

Section: Discussionmentioning

confidence: 99%

Dysphagia in infants with single ventricle anatomy following stage 1 palliation: Physiologic correlates and response to treatment

McGrattan

McGhee

DeToma

et al. 2017

Congenital Heart Disease

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Background Deficits in swallowing physiology are a leading morbidity for infants with functional single ventricles and systemic outflow tract obstruction following stage 1 palliation. Despite the high prevalence of this condition, the underlying deficits that cause this post-operative impairment remain poorly understood. Objective Identify the physiologic correlates of dysphagia in infants with functional single ventricles and systemic outflow tract obstruction following stage 1 palliative surgery. Methods Postoperative fiberoptic laryngoscopies and videofluoroscopic swallow studies (VFSS) were conducted sequentially on infants with functional single ventricles following stage 1 palliative surgery. Infants were dichotomized as having normal or impaired laryngeal function based on laryngoscopy findings. VFSS were evaluated frame-by-frame using a scale that quantifies performance within 11 components of swallowing physiology. Physiologic attributes within each component were categorized as high functioning or low functioning based on their ability to support milk ingestion without bolus airway entry. Results Thirty-six infants (25 male) were included in the investigation. Twenty-four underwent the Norwood procedure and twelve underwent the Hybrid procedure. Low function physiologic patterns were observed within multiple swallowing components during the ingestion of thin barium as characterized by ≥ 4 sucks per swallow (36%), initiation of pharyngeal swallow below the level of the valleculae (83%), and incomplete late laryngeal vestibular closure (56%) at the height of the swallow. Swallowing deficits contributed to aspiration in 50% of infants. Although nectar thick liquids reduced the rate of aspiration (p=0.006), aspiration rates remained high (27%). No differences in rates of penetration or aspiration were observed between infants with normal and impaired laryngeal function. Conclusions Deficits in swallowing physiology contribute to penetration and aspiration following stage 1 palliation among infants with normal and impaired laryngeal function. Although thickened liquids may improve airway protection for select infants, they may inhibit their ability to extract the bolus and meet nutritional needs.

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“…With the transition from fetal to neonatal life, the type and amount of disturbance in circulation by a specific cardiac defect will change, as the pulmonary circulation is bypassed in the fetal circulation. In a recent postnatal study, performed before neonatal surgery using phase‐contrast MRI, cerebral blood flow was comparable among neonates with SVP, TGA, CoA ( n =32), and healthy controls ( n =31). However, both SVP and TGA had reduced oxygen delivery to the brain compared with neonates with CoA and healthy controls.…”

Section: Fetal and Neonatal Cardiovascular Physiology And Brain Bloodmentioning

confidence: 96%

“…All studies of fetal and neonatal brain volumes (Table ) show significant reductions in total brain volume, white matter, and cortical gray matter (CGM) in CHD when compared with controls . With increasing gestational age, greater deviation of total brain volume in CHD is seen during the antenatal period …”

Section: Macrostructural Brain Development In Fetuses and Infants Witmentioning

confidence: 99%

Neuroimaging, cardiovascular physiology, and functional outcomes in infants with congenital heart disease

Claessens

Kelly

Counsell

2017

Develop Med Child Neuro

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This review integrates data on brain dysmaturation and acquired brain injury using fetal and neonatal magnetic resonance imaging (MRI), including the contribution of cardiovascular physiology to differences in brain development, and the relationship between brain abnormalities and subsequent neurological impairments in infants with congenital heart disease (CHD). The antenatal and neonatal period are critical for optimal brain development; the developing brain is particularly vulnerable to haemodynamic disturbances during this time. Altered cerebral perfusion and decreased cerebral oxygen delivery in the antenatal period can affect functional and structural brain development, while postnatal haemodynamic fluctuations may cause additional injury. In critical CHD, brain dysmaturation and acquired brain injury result from a combination of underlying cardiovascular pathology and surgery performed in the neonatal period. MRI findings in infants with CHD can be used to evaluate potential clinical risk factors for brain abnormalities, and aid prediction of functional outcomes at an early stage. In addition, information on timing of brain dysmaturation and acquired brain injury in CHD has the potential to be used when developing strategies to optimize neurodevelopment.

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Cerebral oxygen delivery is reduced in newborns with congenital heart disease

Cited by 69 publications

References 38 publications

Structural brain abnormalities in adolescents and young adults with congenital heart defect: a systematic review

Structural brain abnormalities in adolescents and young adults with congenital heart defect: a systematic review

Dysphagia in infants with single ventricle anatomy following stage 1 palliation: Physiologic correlates and response to treatment

Neuroimaging, cardiovascular physiology, and functional outcomes in infants with congenital heart disease

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