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Delaying heart surgery in newborns may raise risk for brain injury
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Results from a new study found that newborns with hypoplastic left heart syndrome or transposition of the great arteries who do not undergo surgery within 4 days of birth have greater exposure to insufficient cerebral oxygen delivery, which increases the risk for hypoxic ischemic brain injury.
Maryam Y. Naim, MD, of The Children’s Hospital of Philadelphia and University of Pennsylvania, and colleagues compared preoperative cerebral oxygen metabolism and blood flow in newborns with hypoplastic left heart syndrome or transposition of the great arteries, and investigated whether there were distinctions based on age at time of surgery.
“We know that many survivors of these surgeries later in life have developmental impairment,” Naim said.
Maryam Y. Naim
The retrospective study included 28 newborns with hypoplastic left heart syndrome and 14 with transposition of the great arteries from a cohort enrolled in a larger prospective study. The researchers used two noninvasive, light-based imaging techniques: diffuse optical spectroscopy to quantify cerebral saturations and diffuse correlation spectroscopy to evaluate cerebral blood flow. The results were presented at Cardiology 2014: The 17th Annual Update on Pediatric and Congenital Cardiovascular Disease.
Newborns with hypoplastic left heart syndrome had significantly higher oxygen extraction and lower cerebral blood flow compared with those with transposition of the great arteries (P<.01).
“This is something that would almost be expected, given that babies with hypoplastic left heart syndrome have very different anatomy and have retrograde cerebral blood flow compared to babies with transposition of the great arteries,” Naim said.
When analyzing all newborns, the researchers found a linear decrease in cerebral oxygen saturation the longer it took for surgery to be performed.
In addition, oxygen extraction was increased in newborns with hypoplastic left heart syndrome and transposition of the great arteries who underwent surgery 4 or more days after birth compared with those who underwent surgery within 4 days of birth. Later surgery was also associated with “much lower” cerebral oxygen saturation and lower cerebral blood flow in patients with hypoplastic left heart syndrome, Naim said.
In addition, she said, in newborns with either condition, “the metabolic rate of oxygen … was much lower than in published controls, and this is most likely secondary to impaired oxygen delivery preoperatively in these babies.”
For more information:
Naim MY. Abstract #786. Presented at: Cardiology 2014, the 17th Annual Update on Pediatric and Congenital Cardiovascular Disease; Feb. 19-23, 2014; Lake Buena Vista, Fla.
Disclosure: Naim reports no relevant financial disclosures.