Oxygen saturations and neurodevelopmental outcomes in single ventricle heart disease

Abstract

Objectives To evaluate whether the degree of hypoxemia following stage‐I and stage‐II palliative surgeries predicts neurodevelopmental outcomes at 14 months of age in children with single ventricle congenital heart disease (SVCHD). Design We analyzed longitudinal data from two Pediatric Heart Network (PHN) randomized controlled trials, with a total of 328 subjects. Oxygen saturations, measured via pulse oximetry, at time of discharge from stage‐I and stage‐II surgeries were the primary predictors of interest, and Bayley Scales of Infant Development‐II (BSID‐II) scores at 14 months old were the primary outcome measure. Relevant covariates from previously‐published PHN studies were also included in regression models. Results Oxygen saturations at time of discharge from stage‐I and stage‐II surgeries were not related to BSID‐II scores. Having one or more oxygen saturation measurements below 80% was also not associated with BSID‐II scores, and neither was change in oxygen saturations over time. These relationships were not altered by inclusion of relevant covariates. Conclusions In this large cohort of children with SVCHD, oxygen saturations post‐stage‐I and post‐stage‐II palliation surgeries as measured via pulse oximetry were not associated with neurodevelopmental outcomes at 14 months of age. The relationship between oxygen saturations and neurodevelopment in SVCHD is likely complex, and neurodevelopment is known to be affected by a number of factors. Pulse oximetry may also be an insufficient proxy for cerebral oxygen delivery. Clinically, pulse oximetry readings during the interstage and post‐stage‐II surgery periods are not a reliable predictor of future neurodevelopmental risk.

Neuroplacentology in congenital heart disease: placental connections to neurodevelopmental outcomes

“… 46 In a cohort of 328 children with single-ventricle physiology from the Pediatric Heart Network, Wolfe et al found no relationship between peripheral oxygen saturations following state I and stage II palliative surgeries and neurodevelopmental outcomes at 14 months, even when controlling for relevant covariates (any SpO 2 <80% relative risk 2.25 [95% confidence interval (CI) −1.55, 6.06], p = 0.247). 47 …”

Research gaps in the neurodevelopmental assessment of children with complex congenital heart defects: a scoping review

“…Most studies (58%) used a retrospective, cross-sectional, or mixed study design, while the remaining 42% used a prospective and/or longitudinal design. Less than half of the studies (30/78, 38%) included representative samples that did not exclude severely affected children ( 28 – 31 , 33 – 35 , 37 – 45 , 48 – 52 , 56 , 60 – 63 , 74 , 79 , 82 , 84 , 85 ). Notably, 50% of the 78 articles excluded children with various syndromes, and 12% excluded children with cognitive disabilities.…”

Neurodevelopmental outcomes in congenital heart disease through the lens of single ventricle patients

“…Evaluating the impact of gestational age on neurodevelopmental outcomes in adolescents with single ventricle physiology, relative to the full-term group of 100 patients, the 33 early-term patients scored significantly worse on daily-life executive function ratings, were more likely to carry a diagnosis of attention-deficit/hyperactivity disorder and were more likely to have greater psychiatric symptom severity [48]. Further, a cohort of 68 single ventricle patients demonstrated that sleep-disordered breathing correlated with poorer executive function and lower arterial blood oxygen content was associated with poorer executive functioning [49]. Further, atrioventricular valve regurgitation was related to lower parent-rated adaptive function [49].…”

“…Further, a cohort of 68 single ventricle patients demonstrated that sleep-disordered breathing correlated with poorer executive function and lower arterial blood oxygen content was associated with poorer executive functioning [49]. Further, atrioventricular valve regurgitation was related to lower parent-rated adaptive function [49].…”