Neurological Monitoring and Outcome

Infants who undergo repair of congenital heart lesions are at risk of acute neurologic injury and subsequent developmental delay and neurocognitive impairment. Several aspects of management, especially the cardiopulmonary bypass strategies are known to impact cerebral blood flow, but no neuroprotective practice has been established as a standard for the management of these fragile patients. Neuromonitoring modalities are available for care optimization targeting oxygen delivery, but they have not demonstrated an ability to improve patient outcome. This chapter reviews cerebral physiology during cardiac surgery, bypass, and deep hypothermia. Cerebral monitoring modalities are then reviewed. Finally longer term neurodevelopmental outcomes after cardiac surgery are presented.