Document Detail


Neurodevelopmental outcomes after regional cerebral perfusion with neuromonitoring for neonatal aortic arch reconstruction.
MedLine Citation:
PMID:  22766302     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Dean B Andropoulos; R Blaine Easley; Ken 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
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-07-04
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  95     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-22     Completed Date:  2013-03-26     Revised Date:  2014-02-04    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  648-54; discussion 654-5     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Aorta, Thoracic / surgery*
Cardiac Surgical Procedures* / adverse effects,  methods
Cerebrovascular Circulation*
Humans
Infant, Newborn
Monitoring, Intraoperative / methods*
Nervous System / growth & development*
Perfusion*
Prospective Studies
Spectroscopy, Near-Infrared
Treatment Outcome
Ultrasonography, Doppler, Transcranial
Grant Support
ID/Acronym/Agency:
1R21-HD55501-01/HD/NICHD NIH HHS; M01 RR000188/RR/NCRR NIH HHS; R21 HD055501/HD/NICHD NIH HHS
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