Abstract 18564: Redefining the Incidence and Impact of Acute Brain Injury After Neonatal Cardiac Surgery
Introduction: Whilst the reported incidence of acute brain injury (ABI) after paediatric cardiac surgery at all ages is around 2%, the true incidence and impact of ABI in neonatal cardiac surgery are not well defined and are the focus of this study.
Methods: Neonates undergoing cardiac surgery with cardiopulmonary bypass (CPB) between July 2011 and December 2014 were identified. 134 patients were enrolled; 29 Norwood cases (22%) and 105 non-Norwood cases (78%). Clinical data were retrospectively collected including neurodevelopmental assessments (Bayley-III Scales) at one year. All imaging abnormalities as well as seizures and abnormal EEG results were recorded. Post-operative changes were considered ABI.
Results: Preoperative neuroimaging or EEG abnormalities were evident in 6%, with an ABI rate of 17% post-operatively, totalling 23% with pre and/or post-operative neurologic abnormality. There were higher rates of abnormality in the Norwood group compared to the non-Norwood group (41% vs 18%, p=0.008). Significant predictors of ABI on multivariate regression analysis were use of ECMO (p<0.001) and cardiac arrest (p=0.01). Bayley-III assessments were complete in 50% of the cohort at 1 year of age. Those with recorded neurologic abnormalities had significantly worse developmental delay (scoring below average in two or more domains) compared to those with no abnormality (86% vs 44% respectively, p=0.005). ABI was a predictor of delay (p=0.012) on univariate analysis. The only other variable found to predict neurodevelopmental delay was length of stay (p=0.026). No other clinical or operative characteristics, including circulatory arrest, were predictive.
Conclusion: In neonates undergoing CPB, the rate of ABI is substantially higher than previously described. The incidence of ABI varies according to procedural complexity and is underestimated in the paediatric literature. Although clinical recovery after ABI in neonates is usually rapid and apparently complete, the risk of subsequent neurodevelopmental disability is significantly increased.
Author Disclosures: C. Verrall: None. K. Walker: None. A. Loughran-Fowlds: None. C. Troedson: None. J. Ayer: None. J. Egan: None. R. Halliday: None. Y. Orr: None. G. Sholler: None. G. Sholler: None. N. Badawi: None. D.S. Winlaw: None.
- © 2016 by American Heart Association, Inc.