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Early heart surgery in newborns may reduce neurodevelopmental impairment
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Performing surgery to correct hypoplastic left heart syndrome early — within 4 days of birth in one cohort — may reduce an infant’s risk for periventricular leukomalacia.
Periventricular leukomalacia, also known as hypoxic-ischemic white matter injury, is linked to neurodevelopmental dysfunction. It is a common complication from infant heart surgery and is particularly high in those with hypoplastic left heart syndrome, Jennifer Lynch, MS, of the University of Pennsylvania, said during a presentation at Cardiology 2014: The 17th Annual Update on Pediatric and Congenital Cardiovascular Disease.
Lynch and colleagues aimed to identify risks for periventricular leukomalacia, which could lead to development of new prevention strategies.
Jennifer Lynch
The researchers performed brain MRIs on 37 newborns (mean gestational age, 38.9 weeks; 18 boys) with hypoplastic left heart syndrome before and after surgery to assess periventricular leukomalacia volume. They quantified preoperative cerebral oxygen saturation and a cerebral blood flow index using frequency domain diffuse optical spectroscopy and diffuse correlation spectroscopy.
Longer time from birth to surgery, lower preoperative cerebral oxygen saturation and higher preoperative blood flow index were predictive of the amount of periventricular leukomalacia.
Newborns who underwent surgery within 4 days of birth developed significantly less periventricular leukomalacia compared with those who had surgery after day 4 (P<.001), according to Lynch.
The researchers also found a significant and negative linear relationship between day of life and cerebral oxygen saturation (P<.05). According to Lynch, this could indicate that deteriorating cerebral oxygenation before surgery contributes to increased risk for periventricular leukomalacia.
“The idea is to see how much oxygen delivery is sufficient for them to be protected from this brain injury,” she said.
Lynch was awarded the Cardiology 2014 Outstanding Investigator of the Year Award for this abstract.
For more information:
Lynch JM. Abstract #744. Presented at: Cardiology 2014, the 17th Annual Update on Pediatric and Congenital Cardiovascular Disease; Feb. 19-23, 2014; Lake Buena Vista, Fla.
Disclosure: Lynch reports no relevant financial disclosures.