Elevated cranial ultrasound resistive indices are associated with improved neurodevelopmental outcomes one year after pediatric cardiac surgery

A single center pilot study

Christopher L. Jenks*, Ana Hernandez, Peter L. Stavinoha, Michael C. Morris, Fenghua Tian, Hanli Liu, Parvesh Garg, Joseph M. Forbess, Joshua Koch

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Objective To determine if a non-invasive, repeatable test can be used to predict neurodevelopmental outcomes in patients with congenital heart disease. Methods This was a prospective study of pediatric patients less than two months of age undergoing congenital heart surgery at the Children's Health Children's Medical Center at Dallas. Multichannel near-infrared spectroscopy (NIRS) was utilized during the surgery, and ultrasound (US) resistive indices (RI) of the major cranial vessels were obtained prior to surgery, immediately post-operatively, and prior to discharge. Pearson's correlation, Fischer exact t test, and Fischer r to z transformation were used where appropriate. Results A total of 16 patients were enrolled. All had US data. Of the sixteen patients, two died prior to the neurodevelopmental testing, six did not return for the neurodevelopmental testing, and eight patients completed the neurodevelopmental testing. There were no significant correlations between the prior to surgery and prior to discharge US RI and neurodevelopmental outcomes. The immediate post-operative US RI demonstrated a strong positive correlation with standardized neurodevelopmental outcome measures. We were able to demonstrate qualitative differences using multichannel NIRS during surgery, but experienced significant technical difficulties implementing consistent monitoring. Conclusions A higher resistive index in the major cerebral blood vessels following cardiac surgery in the neonatal period is associated with improved neurological outcomes one year after surgery. Obtaining an ultrasound with resistive indices of the major cerebral vessels prior to and after surgery may yield information that is predictive of neurodevelopmental outcomes.

Original languageEnglish (US)
Pages (from-to)251-257
Number of pages7
JournalHeart and Lung: Journal of Acute and Critical Care
Volume46
Issue number4
DOIs
StatePublished - Jul 1 2017

Fingerprint

Thoracic Surgery
Pediatrics
Near-Infrared Spectroscopy
Blood Vessels
Heart Diseases
Outcome Assessment (Health Care)
Prospective Studies

Keywords

  • Near-infrared spectroscopy
  • Neurodevelopmental outcomes
  • Pediatric cardiac intensive care
  • Pediatric congenital heart surgery
  • Ultrasound resistive indices

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Jenks, Christopher L. ; Hernandez, Ana ; Stavinoha, Peter L. ; Morris, Michael C. ; Tian, Fenghua ; Liu, Hanli ; Garg, Parvesh ; Forbess, Joseph M. ; Koch, Joshua. / Elevated cranial ultrasound resistive indices are associated with improved neurodevelopmental outcomes one year after pediatric cardiac surgery : A single center pilot study. In: Heart and Lung: Journal of Acute and Critical Care. 2017 ; Vol. 46, No. 4. pp. 251-257.
@article{a207869da5be4604864219b40294cbab,
title = "Elevated cranial ultrasound resistive indices are associated with improved neurodevelopmental outcomes one year after pediatric cardiac surgery: A single center pilot study",
abstract = "Objective To determine if a non-invasive, repeatable test can be used to predict neurodevelopmental outcomes in patients with congenital heart disease. Methods This was a prospective study of pediatric patients less than two months of age undergoing congenital heart surgery at the Children's Health Children's Medical Center at Dallas. Multichannel near-infrared spectroscopy (NIRS) was utilized during the surgery, and ultrasound (US) resistive indices (RI) of the major cranial vessels were obtained prior to surgery, immediately post-operatively, and prior to discharge. Pearson's correlation, Fischer exact t test, and Fischer r to z transformation were used where appropriate. Results A total of 16 patients were enrolled. All had US data. Of the sixteen patients, two died prior to the neurodevelopmental testing, six did not return for the neurodevelopmental testing, and eight patients completed the neurodevelopmental testing. There were no significant correlations between the prior to surgery and prior to discharge US RI and neurodevelopmental outcomes. The immediate post-operative US RI demonstrated a strong positive correlation with standardized neurodevelopmental outcome measures. We were able to demonstrate qualitative differences using multichannel NIRS during surgery, but experienced significant technical difficulties implementing consistent monitoring. Conclusions A higher resistive index in the major cerebral blood vessels following cardiac surgery in the neonatal period is associated with improved neurological outcomes one year after surgery. Obtaining an ultrasound with resistive indices of the major cerebral vessels prior to and after surgery may yield information that is predictive of neurodevelopmental outcomes.",
keywords = "Near-infrared spectroscopy, Neurodevelopmental outcomes, Pediatric cardiac intensive care, Pediatric congenital heart surgery, Ultrasound resistive indices",
author = "Jenks, {Christopher L.} and Ana Hernandez and Stavinoha, {Peter L.} and Morris, {Michael C.} and Fenghua Tian and Hanli Liu and Parvesh Garg and Forbess, {Joseph M.} and Joshua Koch",
year = "2017",
month = "7",
day = "1",
doi = "10.1016/j.hrtlng.2017.04.009",
language = "English (US)",
volume = "46",
pages = "251--257",
journal = "Heart and Lung: Journal of Acute and Critical Care",
issn = "0147-9563",
publisher = "Mosby Inc.",
number = "4",

}

Elevated cranial ultrasound resistive indices are associated with improved neurodevelopmental outcomes one year after pediatric cardiac surgery : A single center pilot study. / Jenks, Christopher L.; Hernandez, Ana; Stavinoha, Peter L.; Morris, Michael C.; Tian, Fenghua; Liu, Hanli; Garg, Parvesh; Forbess, Joseph M.; Koch, Joshua.

In: Heart and Lung: Journal of Acute and Critical Care, Vol. 46, No. 4, 01.07.2017, p. 251-257.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Elevated cranial ultrasound resistive indices are associated with improved neurodevelopmental outcomes one year after pediatric cardiac surgery

T2 - A single center pilot study

AU - Jenks, Christopher L.

AU - Hernandez, Ana

AU - Stavinoha, Peter L.

AU - Morris, Michael C.

AU - Tian, Fenghua

AU - Liu, Hanli

AU - Garg, Parvesh

AU - Forbess, Joseph M.

AU - Koch, Joshua

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Objective To determine if a non-invasive, repeatable test can be used to predict neurodevelopmental outcomes in patients with congenital heart disease. Methods This was a prospective study of pediatric patients less than two months of age undergoing congenital heart surgery at the Children's Health Children's Medical Center at Dallas. Multichannel near-infrared spectroscopy (NIRS) was utilized during the surgery, and ultrasound (US) resistive indices (RI) of the major cranial vessels were obtained prior to surgery, immediately post-operatively, and prior to discharge. Pearson's correlation, Fischer exact t test, and Fischer r to z transformation were used where appropriate. Results A total of 16 patients were enrolled. All had US data. Of the sixteen patients, two died prior to the neurodevelopmental testing, six did not return for the neurodevelopmental testing, and eight patients completed the neurodevelopmental testing. There were no significant correlations between the prior to surgery and prior to discharge US RI and neurodevelopmental outcomes. The immediate post-operative US RI demonstrated a strong positive correlation with standardized neurodevelopmental outcome measures. We were able to demonstrate qualitative differences using multichannel NIRS during surgery, but experienced significant technical difficulties implementing consistent monitoring. Conclusions A higher resistive index in the major cerebral blood vessels following cardiac surgery in the neonatal period is associated with improved neurological outcomes one year after surgery. Obtaining an ultrasound with resistive indices of the major cerebral vessels prior to and after surgery may yield information that is predictive of neurodevelopmental outcomes.

AB - Objective To determine if a non-invasive, repeatable test can be used to predict neurodevelopmental outcomes in patients with congenital heart disease. Methods This was a prospective study of pediatric patients less than two months of age undergoing congenital heart surgery at the Children's Health Children's Medical Center at Dallas. Multichannel near-infrared spectroscopy (NIRS) was utilized during the surgery, and ultrasound (US) resistive indices (RI) of the major cranial vessels were obtained prior to surgery, immediately post-operatively, and prior to discharge. Pearson's correlation, Fischer exact t test, and Fischer r to z transformation were used where appropriate. Results A total of 16 patients were enrolled. All had US data. Of the sixteen patients, two died prior to the neurodevelopmental testing, six did not return for the neurodevelopmental testing, and eight patients completed the neurodevelopmental testing. There were no significant correlations between the prior to surgery and prior to discharge US RI and neurodevelopmental outcomes. The immediate post-operative US RI demonstrated a strong positive correlation with standardized neurodevelopmental outcome measures. We were able to demonstrate qualitative differences using multichannel NIRS during surgery, but experienced significant technical difficulties implementing consistent monitoring. Conclusions A higher resistive index in the major cerebral blood vessels following cardiac surgery in the neonatal period is associated with improved neurological outcomes one year after surgery. Obtaining an ultrasound with resistive indices of the major cerebral vessels prior to and after surgery may yield information that is predictive of neurodevelopmental outcomes.

KW - Near-infrared spectroscopy

KW - Neurodevelopmental outcomes

KW - Pediatric cardiac intensive care

KW - Pediatric congenital heart surgery

KW - Ultrasound resistive indices

UR - http://www.scopus.com/inward/record.url?scp=85018892545&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85018892545&partnerID=8YFLogxK

U2 - 10.1016/j.hrtlng.2017.04.009

DO - 10.1016/j.hrtlng.2017.04.009

M3 - Article

VL - 46

SP - 251

EP - 257

JO - Heart and Lung: Journal of Acute and Critical Care

JF - Heart and Lung: Journal of Acute and Critical Care

SN - 0147-9563

IS - 4

ER -