Neurodevelopmental outcomes after regional cerebral perfusion with neuromonitoring for neonatal aortic arch reconstruction

Dean B. Andropoulos; R. Blaine Easley; Kenneth Martin Brady; E. Dean McKenzie; Jeffrey S. Heinle; Heather A. Dickerson; Lara S. Shekerdemian; Marcie Meador; Carol Eisenman; Jill V. Hunter; Marie Turcich; Robert G. Voigt; Charles D. Fraser

doi:10.1016/j.athoracsur.2012.04.070

Neurodevelopmental outcomes after regional cerebral perfusion with neuromonitoring for neonatal aortic arch reconstruction

Dean B. Andropoulos^*, R. Blaine Easley, Kenneth Martin Brady, E. Dean McKenzie, Jeffrey S. Heinle, Heather A. Dickerson, Lara S. Shekerdemian, Marcie Meador, Carol Eisenman, Jill V. Hunter, Marie Turcich, Robert G. Voigt, Charles D. Fraser

^*Corresponding author for this work

Pediatrics

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76 Scopus citations

Abstract

Background: In this study we report magnetic resonance imaging (MRI) brain injury and 12-month neurodevelopmental outcomes when regional cerebral perfusion (RCP) is used for neonatal aortic arch reconstruction. Methods: Fifty-seven neonates receiving RCP during aortic arch reconstruction were enrolled in a prospective outcome study. RCP flows were determined by near-infrared spectroscopy and transcranial Doppler monitoring. Brain MRI was performed preoperatively and 7 days postoperatively. Bayley Scales of Infant Development III was performed at 12 months. Results: Mean RCP time was 71 ± 28 minutes (range, 5 to 121 minutes) and mean flow was 56.6 ± 10.6 mL/kg/min. New postoperative MRI brain injury was seen in 40% of patients. For 35 RCP patients at age 12 months, mean Bayley Scales III Composite standard scores were: Cognitive, 100.1 ± 14.6 (range, 75 to 125); Language, 87.2 ± 15.0 (range, 62 to 132); and Motor, 87.9 ± 16.8 (range, 58 to 121). Increasing duration of RCP was not associated with adverse neurodevelopmental outcomes. Conclusions: Neonatal aortic arch repair with RCP using a neuromonitoring strategy results in 12-month cognitive outcomes that are at reference population norms. Language and motor outcomes are lower than the reference population norms by 0.8 to 0.9 standard deviations. The neurodevelopmental outcomes in this RCP cohort demonstrate that this technique is effective and safe in supporting the brain during neonatal aortic arch reconstruction.

Original language	English (US)
Pages (from-to)	648-655
Number of pages	8
Journal	Annals of Thoracic Surgery
Volume	95
Issue number	2
DOIs	https://doi.org/10.1016/j.athoracsur.2012.04.070
State	Published - Feb 2013

Funding

This work was funded in part by National Institutes of Health National Institute of Child Health and Human Development Grant 1R21-HD55501-01 , the Charles A. Dana Foundation, and the Texas Children's Hospital Anesthesiology Research Fund (to D.B.A.).

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Pulmonary and Respiratory Medicine
Surgery

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10.1016/j.athoracsur.2012.04.070

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Andropoulos, D. B., Easley, R. B., Brady, K. M., McKenzie, E. D., Heinle, J. S., Dickerson, H. A., Shekerdemian, L. S., Meador, M., Eisenman, C., Hunter, J. V., Turcich, M., Voigt, R. G., & Fraser, C. D. (2013). Neurodevelopmental outcomes after regional cerebral perfusion with neuromonitoring for neonatal aortic arch reconstruction. Annals of Thoracic Surgery, 95(2), 648-655. https://doi.org/10.1016/j.athoracsur.2012.04.070

@article{d192404ebb134692861360ef2910aa72,

title = "Neurodevelopmental outcomes after regional cerebral perfusion with neuromonitoring for neonatal aortic arch reconstruction",

abstract = "Background: In this study we report magnetic resonance imaging (MRI) brain injury and 12-month neurodevelopmental outcomes when regional cerebral perfusion (RCP) is used for neonatal aortic arch reconstruction. Methods: Fifty-seven neonates receiving RCP during aortic arch reconstruction were enrolled in a prospective outcome study. RCP flows were determined by near-infrared spectroscopy and transcranial Doppler monitoring. Brain MRI was performed preoperatively and 7 days postoperatively. Bayley Scales of Infant Development III was performed at 12 months. Results: Mean RCP time was 71 ± 28 minutes (range, 5 to 121 minutes) and mean flow was 56.6 ± 10.6 mL/kg/min. New postoperative MRI brain injury was seen in 40% of patients. For 35 RCP patients at age 12 months, mean Bayley Scales III Composite standard scores were: Cognitive, 100.1 ± 14.6 (range, 75 to 125); Language, 87.2 ± 15.0 (range, 62 to 132); and Motor, 87.9 ± 16.8 (range, 58 to 121). Increasing duration of RCP was not associated with adverse neurodevelopmental outcomes. Conclusions: Neonatal aortic arch repair with RCP using a neuromonitoring strategy results in 12-month cognitive outcomes that are at reference population norms. Language and motor outcomes are lower than the reference population norms by 0.8 to 0.9 standard deviations. The neurodevelopmental outcomes in this RCP cohort demonstrate that this technique is effective and safe in supporting the brain during neonatal aortic arch reconstruction.",

author = "Andropoulos, {Dean B.} and Easley, {R. Blaine} and Brady, {Kenneth Martin} and McKenzie, {E. Dean} and Heinle, {Jeffrey S.} and Dickerson, {Heather A.} and Shekerdemian, {Lara S.} and Marcie Meador and Carol Eisenman and Hunter, {Jill V.} and Marie Turcich and Voigt, {Robert G.} and Fraser, {Charles D.}",

note = "Funding Information: This work was funded in part by National Institutes of Health National Institute of Child Health and Human Development Grant 1R21-HD55501-01 , the Charles A. Dana Foundation, and the Texas Children's Hospital Anesthesiology Research Fund (to D.B.A.). ",

year = "2013",

month = feb,

doi = "10.1016/j.athoracsur.2012.04.070",

language = "English (US)",

volume = "95",

pages = "648--655",

journal = "Annals of Thoracic Surgery",

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Andropoulos, DB, Easley, RB, Brady, KM, McKenzie, ED, Heinle, JS, Dickerson, HA, Shekerdemian, LS, Meador, M, Eisenman, C, Hunter, JV, Turcich, M, Voigt, RG & Fraser, CD 2013, 'Neurodevelopmental outcomes after regional cerebral perfusion with neuromonitoring for neonatal aortic arch reconstruction', Annals of Thoracic Surgery, vol. 95, no. 2, pp. 648-655. https://doi.org/10.1016/j.athoracsur.2012.04.070

TY - JOUR

T1 - Neurodevelopmental outcomes after regional cerebral perfusion with neuromonitoring for neonatal aortic arch reconstruction

AU - Andropoulos, Dean B.

AU - Easley, R. Blaine

AU - Brady, Kenneth Martin

AU - McKenzie, E. Dean

AU - Heinle, Jeffrey S.

AU - Dickerson, Heather A.

AU - Shekerdemian, Lara S.

AU - Meador, Marcie

AU - Eisenman, Carol

AU - Hunter, Jill V.

AU - Turcich, Marie

AU - Voigt, Robert G.

AU - Fraser, Charles D.

N1 - Funding Information: This work was funded in part by National Institutes of Health National Institute of Child Health and Human Development Grant 1R21-HD55501-01 , the Charles A. Dana Foundation, and the Texas Children's Hospital Anesthesiology Research Fund (to D.B.A.).

PY - 2013/2

Y1 - 2013/2

N2 - Background: In this study we report magnetic resonance imaging (MRI) brain injury and 12-month neurodevelopmental outcomes when regional cerebral perfusion (RCP) is used for neonatal aortic arch reconstruction. Methods: Fifty-seven neonates receiving RCP during aortic arch reconstruction were enrolled in a prospective outcome study. RCP flows were determined by near-infrared spectroscopy and transcranial Doppler monitoring. Brain MRI was performed preoperatively and 7 days postoperatively. Bayley Scales of Infant Development III was performed at 12 months. Results: Mean RCP time was 71 ± 28 minutes (range, 5 to 121 minutes) and mean flow was 56.6 ± 10.6 mL/kg/min. New postoperative MRI brain injury was seen in 40% of patients. For 35 RCP patients at age 12 months, mean Bayley Scales III Composite standard scores were: Cognitive, 100.1 ± 14.6 (range, 75 to 125); Language, 87.2 ± 15.0 (range, 62 to 132); and Motor, 87.9 ± 16.8 (range, 58 to 121). Increasing duration of RCP was not associated with adverse neurodevelopmental outcomes. Conclusions: Neonatal aortic arch repair with RCP using a neuromonitoring strategy results in 12-month cognitive outcomes that are at reference population norms. Language and motor outcomes are lower than the reference population norms by 0.8 to 0.9 standard deviations. The neurodevelopmental outcomes in this RCP cohort demonstrate that this technique is effective and safe in supporting the brain during neonatal aortic arch reconstruction.

AB - Background: In this study we report magnetic resonance imaging (MRI) brain injury and 12-month neurodevelopmental outcomes when regional cerebral perfusion (RCP) is used for neonatal aortic arch reconstruction. Methods: Fifty-seven neonates receiving RCP during aortic arch reconstruction were enrolled in a prospective outcome study. RCP flows were determined by near-infrared spectroscopy and transcranial Doppler monitoring. Brain MRI was performed preoperatively and 7 days postoperatively. Bayley Scales of Infant Development III was performed at 12 months. Results: Mean RCP time was 71 ± 28 minutes (range, 5 to 121 minutes) and mean flow was 56.6 ± 10.6 mL/kg/min. New postoperative MRI brain injury was seen in 40% of patients. For 35 RCP patients at age 12 months, mean Bayley Scales III Composite standard scores were: Cognitive, 100.1 ± 14.6 (range, 75 to 125); Language, 87.2 ± 15.0 (range, 62 to 132); and Motor, 87.9 ± 16.8 (range, 58 to 121). Increasing duration of RCP was not associated with adverse neurodevelopmental outcomes. Conclusions: Neonatal aortic arch repair with RCP using a neuromonitoring strategy results in 12-month cognitive outcomes that are at reference population norms. Language and motor outcomes are lower than the reference population norms by 0.8 to 0.9 standard deviations. The neurodevelopmental outcomes in this RCP cohort demonstrate that this technique is effective and safe in supporting the brain during neonatal aortic arch reconstruction.

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SN - 0003-4975

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JO - Annals of Thoracic Surgery

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Neurodevelopmental outcomes after regional cerebral perfusion with neuromonitoring for neonatal aortic arch reconstruction

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