Neuromonitoring, neuroimaging, and neurodevelopmental follow-up practices in neonatal congenital heart disease: a European survey

Abstract

Background Brain injury and neurodevelopmental impairment remain a concern in children with complex congenital heart disease (CHD). A practice guideline on neuromonitoring, neuroimaging, and neurodevelopmental follow-up in CHD patients undergoing cardiopulmonary bypass surgery is lacking. The aim of this survey was to systematically evaluate the current practice in centers across Europe. Methods An online-based structured survey was sent to pediatric cardiac surgical centers across Europe between April 2019 and June 2020. Results were summarized by descriptive statistics. Results Valid responses were received by 25 European centers, of which 23 completed the questionnaire to the last page. Near-infrared spectroscopy was the most commonly used neuromonitoring modality used in 64, 80, and 72% preoperatively, intraoperatively, and postoperatively, respectively. Neuroimaging was most commonly performed by means of cranial ultrasound in 96 and 84% preoperatively and postoperatively, respectively. Magnetic resonance imaging was obtained in 72 and 44% preoperatively and postoperatively, respectively, but was predominantly reserved for clinically symptomatic patients (preoperatively 67%, postoperatively 64%). Neurodevelopmental follow-up was implemented in 40% of centers and planned in 24%. Conclusions Heterogeneity in perioperative neuromonitoring and neuroimaging practice in CHD in centers across Europe is large. The need for neurodevelopmental follow-up has been recognized. A clear practice guideline is urgently needed. Impact There is large heterogeneity in neuromonitoring, neuroimaging, and neurodevelopmental follow-up practices among European centers caring for neonates with complex congenital heart disease. This study provides a systematic evaluation of the current neuromonitoring, neuroimaging, and neurodevelopmental follow-up practice in Europe. The results of this survey may serve as the basis for developing a clear practice guideline that could help to early detect and prevent neurological and neurodevelopmental sequelae in neonates with complex congenital heart disease.

Implementing neurodevelopmental follow‐up care for children with congenital heart disease: A scoping review with evidence mapping

“…Surveys of neurodevelopmental follow‐up in Canada, Europe, and the UK highlighted the importance of having evidence‐based guidance to support standardization across geographical contexts, but which was also relevant to the local setting 15,16,43 . Guidelines produced in one setting may not always be appropriate for use in another, even with the same underpinning evidence.…”

“…Of these, 21 studies examined the implementation of specific programmes or care pathways for neurodevelopmental follow-up care, [27][28][29][31][32][33][34][35][36][38][39][40]42,44,[47][48][49][50][51][52][53][54]56 and 12 studies reported on surveys or overviews of current clinical practices in neurodevelopmental follow-up. 9,[13][14][15][16]30,37,41,43,45,46,55 Implementation and evaluation of follow-up programmes or care pathways All studies were published after 2011, with most (15 out of 21) conducted since 2018. Fourteen of the studies reported on neurodevelopmental care pathways or programmes based in the USA, 27,[32][33][34][35][36][38][39][40]42,44,[46]…”

“…Moreover, no recent research has built on early attempts to synthesize common programme approaches and implementation challenges 12 . Surveys of current practice have also highlighted considerable variability in the delivery of neurodevelopmental follow‐up care both within and across countries 13–16 . Importantly, understanding different programme approaches and pathways of care that can be adopted is critical to guide context‐relevant implementation, inform scale‐up, and perform comparative evaluation of their effectiveness in practice 10 …”

Similarities and Differences in the Neurodevelopmental Outcome of Children with Congenital Heart Disease and Children Born Very Preterm at School Entry

“…44 Although the need for standardized neurodevelopmental follow-up programs is recognized and specific recommendations have been issued, 45,46 the implementation is heterogeneous across different centers within and between countries. 47,48 Further, neurodevelopmental follow-up is often only available for those children with CHD considered at highest risk for neurodevelopmental impairments rather than for all children with CHD after open heart surgery. 47 Structured long-term evaluation programs for all high-risk children surviving neonatal critical illness are needed to ensure adequate follow-up care for these children as they grow.…”

The Year in Review: Anesthesia for Congenital Heart Disease 2022

“…Two centers (8%) reported no use of intraoperative neuromonitoring. 44 Given the relatively common use of NIRS, Loomba et al performed a systematic review with the objective of determining the correlation of NIRS oximetry and corresponding venous oxygen saturations using pooled analysis. A total of 13 studies, including 562 patients, showed a strong correlation (pooled correlation coefficient = 0.7, 95% CI 0.55-0.80) between cerebral NIRS oximetry values and superior vena cava or jugular venous oxygen saturations.…”