Perioperative Cerebral Oxygenation Metabolism in Neonates with Hypoplastic Left Heart Syndrome or Transposition of the Great Arteries

Neunhoeffer, Felix; Hofbeck, Michael; Schlensak, Christian; Schuhmann, Martin U.; Michel, Jörg

doi:10.1007/s00246-018-1952-2

Cited by 8 publications

(7 citation statements)

References 21 publications

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“…Unadjusted fractional tissue oxygen extraction values were significantly higher in CHD compared with control infants (p<0.02), indicating that CHD newborns either have increased cerebral metabolic rate or decreased oxygen delivery. Prior studies have reported higher fractional tissue oxygen extraction in term preoperative CHD infants compared with controls, who had fractional tissue oxygen extraction values comparable to our infants [27,[58][59][60]. We also found that higher fractional tissue oxygen extraction values were strongly associated with lower cerebral oxygen saturation levels when accounting for the effects of group and preductal peripheral arterial oxygen saturation on cerebral oxygen saturation values (p = <0.0001), consistent with findings from a study of CHD infants that fractional tissue oxygen extraction increased with declining venous oxygen content [61], a measure akin to NIRS-based cerebral oxygen saturation values.…”

Section: Cerebral Tissue Extractionsupporting

confidence: 83%

Cerebral oxygen saturation and cerebrovascular instability in newborn infants with congenital heart disease compared to healthy controls

et al. 2021

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Objective Infants with Congenital Heart Disease (CHD) are at risk for developmental delays, though the mechanisms of brain injury that impair development are unknown. Potential causes could include cerebral hypoxia and cerebrovascular instability. We hypothesized that we would detect significantly reduced cerebral oxygen saturation and greater cerebrovascular instability in CHD infants compared to the healthy controls. Methods We performed a secondary analysis on a sample of 43 term infants (28 CHD, 15 healthy controls) that assessed prospectively in temporal cross-section before or at 12 days of age. CHD infants were assessed prior to open-heart surgery. Cerebral oxygen saturation levels were estimated using Near-Infrared Spectroscopy, and cerebrovascular stability was assessed with the response of cerebral oxygen saturation after a postural change (supine to sitting). Results Cerebral oxygen saturation was 9 points lower in CHD than control infants in both postures (β = -9.3; 95%CI = -17.68, -1.00; p = 0.028), even after controlling for differences in peripheral oxygen saturation. Cerebrovascular stability was significantly impaired in CHD compared to healthy infants (β = -2.4; 95%CI = -4.12, -.61; p = 0.008), and in CHD infants with single ventricle compared with biventricular defects (β = -1.5; 95%CI = -2.95, -0.05; p = 0.04). Conclusion CHD infants had cerebral hypoxia and decreased cerebral oxygen saturation values following a postural change, suggesting cerebrovascular instability. Future longitudinal studies should assess the associations of cerebral hypoxia and cerebrovascular instability with long-term neurodevelopmental outcomes in CHD infants.

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Section: Cerebral Tissue Extractionsupporting

confidence: 83%

Cerebral oxygen saturation and cerebrovascular instability in newborn infants with congenital heart disease compared to healthy controls

et al. 2021

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“…Therefore, we did not observe at which point cerebral oxygenation metabolism may fully recover in neonates and infants with intraoperative cerebral deoxygenations. However, studies in pediatric cardiac surgery showed that raised cFTOE and CMRO 2 after surgery normalized after 24-48 h. 12,21 Another limitation is that the patients' diagnoses, and therefore their operations, varied widely. Also, age and weight differed between the groups although not significantly.…”

Section: Discussionmentioning

confidence: 99%

“…The probe transmits white light (500–800 nm, 1 nm resolution, <30 mW) into the tissue and recollects the reflected light. Based on the analysis of the spectral components of the reflected light in comparison with prerecorded deoxygenated and oxygenated hemoglobin, the device calculates oxygen saturation representing regional cerebral oxygen saturation (rcSO 2 ) (%) 12 . The continuous wave laser Doppler of the device (wavelength 830 nm, <30 mW) allows calculation of microperfusion (rcFlow, arbitrary units [AU]) based on Doppler shift of laser light, which correlates with blood flow velocitiy and the number of moving erythrocytes in the tissue 6,7 .…”

Section: Methodsmentioning

confidence: 99%

“…brain, laser Doppler flowmetry, oxygen, pediatric surgery, postoperative comparison with prerecorded deoxygenated and oxygenated hemoglobin, the device calculates oxygen saturation representing regional cerebral oxygen saturation (rcSO 2 ) (%). 12 The continuous wave laser Doppler of the device (wavelength 830 nm, <30 mW) allows calculation of microperfusion (rcFlow, arbitrary units [AU]) based on Doppler shift of laser light, which correlates with blood flow velocitiy and the number of moving erythrocytes in the tissue. 6,7 O 2 C uses and registers alterations of wavelength of the entire spectrum of white light (500-850 nm), including the wavelength of near infrared light (700-850 nm).…”

Section: Introductionmentioning

confidence: 99%

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The effect of intraoperative cerebral oxygen desaturations on postoperative cerebral oxygen metabolism in neonates and infants a pilot study

Jock,

Neunhoeffer,

Rörden

et al. 2023

Pediatric Anesthesia

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IntroductionCerebral oxygen desaturation during pediatric surgery has been associated with adverse perioperative outcomes. The aim of this pilot study was to analyze the frequency and severity of intraoperative cerebral oxygen desaturations and their impact on postoperative cerebral oxygen metabolism in neonates and infants undergoing pediatric surgery.MethodsIn a prospective pilot study, intra‐ and postoperative regional cerebral oxygen saturation and blood flow were measured noninvasively using a device combining laser Doppler flowmetry and white‐light‐spectrometry. Thirty‐seven consecutive neonates and infants undergoing noncardiac surgery under general anesthesia for more than 30 min and necessity for invasive arterial blood pressure monitoring were included. Patients with pre‐known congenital structural heart disease or cerebral disease were excluded. Continuously brain monitor recording was started in sedated patients before induction of anesthesia (preoperative baseline) and was completed 1 h postoperatively in the PICU in sedated, intubated, and mechanically ventilated states at the PICU (postoperative state). Baseline and postoperative state for cerebral fractional tissue oxygen extraction and approximated cerebral metabolic rate of oxygen were calculated.ResultsSeventeen (46%) of the 37 studied neonates and infants suffered from intraoperative periods of regional cerebral oxygen desaturation below 20% of the baseline (event group). Severity of cerebral desaturations was median 4.0%min/h [range 0.1–58.7; interquartile range [IQR] 0.99–21.29]. In the event group, the duration of surgery was significantly longer (median 135 min [range 11–260; IQR 113.5–167.0] vs median 46.5 min [range 11–180; IQR 30.5–159.3]; difference of −62.94; 95% confidence interval [CI] −105.17 to −20.71; p = .021). In the event group, cerebral fractional tissue oxygen extraction (median 0.41 [range 0.20–0.55; IQR 0.26–0.44] vs. median 0.27 [range 0.11–0.41; IQR 0.20–0.31]; difference of −0.11; 95% CI −0.17 to −0.05; p = .001) and approximated cerebral metabolic rate of oxygen (median 6.15 arbitrary unit [range 2.69–12.07; IQR 5.12–7.21] vs. median 4.14 arbitrary unit [range 1.78–7.86; IQR 3.82–6.31]; difference of −1.76; 95% CI −3.03 to −0.49; p = .009) were significantly higher and the cerebral regional oxygen saturation (median 58.99% [range 44.87–79.1; IQR 54.26–72.61] vs median 70.94% [range 57.9–86.13; IQR 67.07–76.59]; difference of 10.01; 95% CI 4.13–15.90; p = .002) significantly lower after surgery compared to the nonevent group.DiscussionThe increase of approximated cerebral metabolic rate of oxygen could indicate an elevated oxidative energy metabolism in the “stressed” brain, due to repair processes. The increased cerebral fractional tissue oxygen extraction fits with the decreased NIRS cerebral oxygenation. Our data suggest that an increase in cerebral oxygen metabolism was the cause.ConclusionCerebral oxygen desaturation during major surgery in neonates and infants is associated with early postoperative increased cerebral oxygen extraction and possibly increased cerebral oxygen metabolism.

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“…27 Patients with complex CHD are at risk of cerebral hypoxemia before surgery. 6,[28][29][30][31][32] Due to hemodynamic alterations of cerebral blood flow, fetuses with complex CHD might develop brain injury even before birth. Brain development often is delayed and may itself result in greater vulnerability to cerebral white matter injury.…”

Section: Discussionmentioning

confidence: 99%

Glial Fibrillary Acid Protein and Cerebral Oxygenation in Neonates Undergoing Cardiac Surgery

Hansen

Kissner

Chitadze

et al. 2019

Thorac cardiovasc Surg

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Background Neonates undergoing surgery for complex congenital heart disease are at risk of developmental impairment. Hypoxic–ischemic brain injury might be a contributing factor. We aimed to investigate the perioperative release of the astrocyte cytoskeleton component glial fibrillary acid protein and its relation to cerebral oxygenation. Methods Serum glial fibrillary acid protein levels were measured before and 0, 12, 24, and 48 hours after surgery. Reference values were based on preoperative samples; concentrations above the 95th percentile were defined as elevated. Cerebral oxygenation was derived by near-infrared spectroscopy. Results Thirty-six neonates undergoing 38 surgeries utilizing cardiopulmonary bypass were enrolled (complete data available for 35 procedures). Glial fibrillary acid protein was elevated after 18 surgeries (arterial switch: 7/12; Norwood: 5/15; others: 6/8; p = 0.144). Age at surgery was higher in cases with elevated serum levels (6 [4–7] vs. 4 [2–5] days, p = 0.009) and intraoperative cerebral oxygen saturation was lower (70 ± 10% vs. 77 ± 7%, p = 0.029). In cases with elevated postoperative glial fibrillary acid protein, preoperative cerebral oxygen saturation was lower for neonates undergoing the arterial switch operation (55 ± 9% vs. 64 ± 4%, p = 0.048) and age at surgery was higher for neonates with a Norwood procedure (7 [6–8] vs. 5 [4–6] days, p = 0.028). Conclusions Glial fibrillary acid protein was elevated after ∼50% of neonatal cardiac surgeries and was related to cerebral oxygenation and older age at surgery. The potential value as a biomarker for cerebral injury after neonatal cardiac surgery warrants further investigation; in particular, the association with neurodevelopmental outcome needs to be determined.

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Perioperative Cerebral Oxygenation Metabolism in Neonates with Hypoplastic Left Heart Syndrome or Transposition of the Great Arteries

Cited by 8 publications

References 21 publications

Cerebral oxygen saturation and cerebrovascular instability in newborn infants with congenital heart disease compared to healthy controls

Cerebral oxygen saturation and cerebrovascular instability in newborn infants with congenital heart disease compared to healthy controls

The effect of intraoperative cerebral oxygen desaturations on postoperative cerebral oxygen metabolism in neonates and infants a pilot study

Glial Fibrillary Acid Protein and Cerebral Oxygenation in Neonates Undergoing Cardiac Surgery

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