Neurodevelopmental outcome in Hypoplastic left heart syndrome – impact of perioperative cerebral tissue oxygenation of the Norwood procedure
Objectives Patients with hypoplastic left heart syndrome are at risk for neurodevelopmental impairment. Hypoxic-ischemic brain injury during neonatal treatment might be a relevant cause. We evaluated the association between cerebral oxygenation in the perioperative course of the Norwood procedure an...
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| Veröffentlicht in: | The Journal of thoracic and cardiovascular surgery 2016-05, Vol.151 (5), p.1358-1366 |
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| container_title | The Journal of thoracic and cardiovascular surgery |
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| creator | Hansen, Jan H., MD Rotermann, Ina, PsyM Logoteta, Jana, MD Jung, Olaf, MD Dütschke, Peter, MD Scheewe, Jens, MD Kramer, Hans-Heiner, MD, PhD |
| description | Objectives Patients with hypoplastic left heart syndrome are at risk for neurodevelopmental impairment. Hypoxic-ischemic brain injury during neonatal treatment might be a relevant cause. We evaluated the association between cerebral oxygenation in the perioperative course of the Norwood procedure and neurodevelopmental outcome. Methods Cerebral tissue oxygen saturation (ScO2) was obtained by near-infrared spectroscopy for 24 hours before and 48 hours after surgery in 43 patients. Full scale, verbal and performance IQ were evaluated with the Wechsler Preschool and Primary Scale of Intelligence at 4.5 (3.5-6.8) years. Cognitive functions were assessed with the German “Kognitiver Entwicklungstest für das Kindergartenalter” (KET-KID). Results IQ scores and KET-KID percentile ranks were in the lower normal range (Full scale IQ: 94 ±11, verbal IQ: 97 ±13, performance IQ: 93 ±9; KET-KID global: 42 ±27, verbal: 48 ±29, nonverbal: 37 ±23). Scores were below average (Full scale IQ |
| doi_str_mv | 10.1016/j.jtcvs.2016.02.035 |
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Hypoxic-ischemic brain injury during neonatal treatment might be a relevant cause. We evaluated the association between cerebral oxygenation in the perioperative course of the Norwood procedure and neurodevelopmental outcome. Methods Cerebral tissue oxygen saturation (ScO2) was obtained by near-infrared spectroscopy for 24 hours before and 48 hours after surgery in 43 patients. Full scale, verbal and performance IQ were evaluated with the Wechsler Preschool and Primary Scale of Intelligence at 4.5 (3.5-6.8) years. Cognitive functions were assessed with the German “Kognitiver Entwicklungstest für das Kindergartenalter” (KET-KID). Results IQ scores and KET-KID percentile ranks were in the lower normal range (Full scale IQ: 94 ±11, verbal IQ: 97 ±13, performance IQ: 93 ±9; KET-KID global: 42 ±27, verbal: 48 ±29, nonverbal: 37 ±23). Scores were below average (Full scale IQ <85 or KET-KID <16th percentile) in 12 cases. Preoperative ScO2 was lower in patients scoring below average (56.8 ±7.1% vs. 61.7 ±5.8%, p=0.028) and correlated with full scale IQ (r=0.495, p=0.001), verbal IQ (r=0.524, p=0.001), performance IQ (r=0.386, p=0.012) and with global (r=0.360, p=0.018) and verbal (r=0.395, p=0.009) KET-KID scores. A relationship between IQ or KET-KID scores and postoperative ScO2 was not found. Gestational age, head circumference z-score, age at surgery and postoperative length of stay were associated with IQ and KET-KID scores. Conclusions Neurodevelopmental outcome was in the lower normal range. Besides innate patient factors, preoperative cerebral tissue oxygenation is likely an important determinant of cognitive development.</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2016.02.035</identifier><identifier>PMID: 27085616</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Area Under Curve ; Cardiothoracic Surgery ; Cerebrovascular Circulation ; Child ; Child, Preschool ; Cognition Disorders - epidemiology ; Cognition Disorders - etiology ; Cognition Disorders - physiopathology ; Cohort Studies ; Developmental Disabilities - epidemiology ; Developmental Disabilities - etiology ; Developmental Disabilities - physiopathology ; Female ; Follow-Up Studies ; Humans ; Hypoplastic Left Heart Syndrome - complications ; Hypoplastic Left Heart Syndrome - surgery ; hypoplastic left heart syndrome, developmental outcome, near-infrared spectroscopy ; Hypoxia-Ischemia, Brain - etiology ; Hypoxia-Ischemia, Brain - physiopathology ; Hypoxia-Ischemia, Brain - psychology ; Male ; Neuropsychological Tests ; Norwood Procedures - adverse effects ; Norwood Procedures - methods ; Oxygen Consumption - physiology ; Palliative Care - methods ; Perioperative Care - methods ; Retrospective Studies ; Risk Assessment ; ROC Curve ; Spectroscopy, Near-Infrared ; Survivors ; Time Factors ; Treatment Outcome</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2016-05, Vol.151 (5), p.1358-1366</ispartof><rights>The American Association for Thoracic Surgery</rights><rights>2016 The American Association for Thoracic Surgery</rights><rights>Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c525t-688a788d1e44f15b48a7f0f8be21ed70d4da2da800137f98d5b4143d7cc00f443</citedby><cites>FETCH-LOGICAL-c525t-688a788d1e44f15b48a7f0f8be21ed70d4da2da800137f98d5b4143d7cc00f443</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jtcvs.2016.02.035$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27085616$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hansen, Jan H., MD</creatorcontrib><creatorcontrib>Rotermann, Ina, PsyM</creatorcontrib><creatorcontrib>Logoteta, Jana, MD</creatorcontrib><creatorcontrib>Jung, Olaf, MD</creatorcontrib><creatorcontrib>Dütschke, Peter, MD</creatorcontrib><creatorcontrib>Scheewe, Jens, MD</creatorcontrib><creatorcontrib>Kramer, Hans-Heiner, MD, PhD</creatorcontrib><title>Neurodevelopmental outcome in Hypoplastic left heart syndrome – impact of perioperative cerebral tissue oxygenation of the Norwood procedure</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>Objectives Patients with hypoplastic left heart syndrome are at risk for neurodevelopmental impairment. Hypoxic-ischemic brain injury during neonatal treatment might be a relevant cause. We evaluated the association between cerebral oxygenation in the perioperative course of the Norwood procedure and neurodevelopmental outcome. Methods Cerebral tissue oxygen saturation (ScO2) was obtained by near-infrared spectroscopy for 24 hours before and 48 hours after surgery in 43 patients. Full scale, verbal and performance IQ were evaluated with the Wechsler Preschool and Primary Scale of Intelligence at 4.5 (3.5-6.8) years. Cognitive functions were assessed with the German “Kognitiver Entwicklungstest für das Kindergartenalter” (KET-KID). Results IQ scores and KET-KID percentile ranks were in the lower normal range (Full scale IQ: 94 ±11, verbal IQ: 97 ±13, performance IQ: 93 ±9; KET-KID global: 42 ±27, verbal: 48 ±29, nonverbal: 37 ±23). Scores were below average (Full scale IQ <85 or KET-KID <16th percentile) in 12 cases. Preoperative ScO2 was lower in patients scoring below average (56.8 ±7.1% vs. 61.7 ±5.8%, p=0.028) and correlated with full scale IQ (r=0.495, p=0.001), verbal IQ (r=0.524, p=0.001), performance IQ (r=0.386, p=0.012) and with global (r=0.360, p=0.018) and verbal (r=0.395, p=0.009) KET-KID scores. A relationship between IQ or KET-KID scores and postoperative ScO2 was not found. Gestational age, head circumference z-score, age at surgery and postoperative length of stay were associated with IQ and KET-KID scores. Conclusions Neurodevelopmental outcome was in the lower normal range. Besides innate patient factors, preoperative cerebral tissue oxygenation is likely an important determinant of cognitive development.</description><subject>Area Under Curve</subject><subject>Cardiothoracic Surgery</subject><subject>Cerebrovascular Circulation</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Cognition Disorders - epidemiology</subject><subject>Cognition Disorders - etiology</subject><subject>Cognition Disorders - physiopathology</subject><subject>Cohort Studies</subject><subject>Developmental Disabilities - epidemiology</subject><subject>Developmental Disabilities - etiology</subject><subject>Developmental Disabilities - physiopathology</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Hypoplastic Left Heart Syndrome - complications</subject><subject>Hypoplastic Left Heart Syndrome - surgery</subject><subject>hypoplastic left heart syndrome, developmental outcome, near-infrared spectroscopy</subject><subject>Hypoxia-Ischemia, Brain - etiology</subject><subject>Hypoxia-Ischemia, Brain - physiopathology</subject><subject>Hypoxia-Ischemia, Brain - psychology</subject><subject>Male</subject><subject>Neuropsychological Tests</subject><subject>Norwood Procedures - adverse effects</subject><subject>Norwood Procedures - methods</subject><subject>Oxygen Consumption - physiology</subject><subject>Palliative Care - methods</subject><subject>Perioperative Care - methods</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>ROC Curve</subject><subject>Spectroscopy, Near-Infrared</subject><subject>Survivors</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFks9u1DAQxi0EokvhCZCQj1w2jJ1_zgEkVEGLVLWHgsTN8toT6pDEwXYWcusT9MIb8iQ4bOHQCxfbI_--Gc18Q8hzBhkDVr3qsi7qfch4CjLgGeTlA7Jh0NTbSpSfH5INAOfbkvP8iDwJoQOAGljzmBzxGkRZsWpDbi9w9s7gHns3DThG1VM3R-0GpHakZ8vkpl6FaDXtsY30GpWPNCyj8Svy6-YntcOkdKSupRN669Khot0j1ehx51O-aEOYkbofyxcc058bVzheI71w_rtzhk7eaTSzx6fkUav6gM_u7mPy6f27jydn2_PL0w8nb8-3uuRlTP0JVQthGBZFy8pdkcIWWrFDztDUYAqjuFECgOV12wiTEFbkptYaoC2K_Ji8PORNlb_NGKIcbNDY92pENwfJasE5K4pyRfMDqr0LwWMrJ28H5RfJQK5GyE7-MUKuRkjgMhmRVC_uCsy7Ac0_zd_JJ-D1AcDU5t6il0FbHNMYrEcdpXH2PwXe3NPr3o5Wq_4rLhg6N_sxTVAyGZJAXq27sK4Cq9KrafL8N4pRtHk</recordid><startdate>20160501</startdate><enddate>20160501</enddate><creator>Hansen, Jan H., MD</creator><creator>Rotermann, Ina, PsyM</creator><creator>Logoteta, Jana, MD</creator><creator>Jung, Olaf, MD</creator><creator>Dütschke, Peter, MD</creator><creator>Scheewe, Jens, MD</creator><creator>Kramer, Hans-Heiner, MD, PhD</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20160501</creationdate><title>Neurodevelopmental outcome in Hypoplastic left heart syndrome – impact of perioperative cerebral tissue oxygenation of the Norwood procedure</title><author>Hansen, Jan H., MD ; Rotermann, Ina, PsyM ; Logoteta, Jana, MD ; Jung, Olaf, MD ; Dütschke, Peter, MD ; Scheewe, Jens, MD ; Kramer, Hans-Heiner, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c525t-688a788d1e44f15b48a7f0f8be21ed70d4da2da800137f98d5b4143d7cc00f443</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Area Under Curve</topic><topic>Cardiothoracic Surgery</topic><topic>Cerebrovascular Circulation</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Cognition Disorders - epidemiology</topic><topic>Cognition Disorders - etiology</topic><topic>Cognition Disorders - physiopathology</topic><topic>Cohort Studies</topic><topic>Developmental Disabilities - epidemiology</topic><topic>Developmental Disabilities - etiology</topic><topic>Developmental Disabilities - physiopathology</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Hypoplastic Left Heart Syndrome - complications</topic><topic>Hypoplastic Left Heart Syndrome - surgery</topic><topic>hypoplastic left heart syndrome, developmental outcome, near-infrared spectroscopy</topic><topic>Hypoxia-Ischemia, Brain - etiology</topic><topic>Hypoxia-Ischemia, Brain - physiopathology</topic><topic>Hypoxia-Ischemia, Brain - psychology</topic><topic>Male</topic><topic>Neuropsychological Tests</topic><topic>Norwood Procedures - adverse effects</topic><topic>Norwood Procedures - methods</topic><topic>Oxygen Consumption - physiology</topic><topic>Palliative Care - methods</topic><topic>Perioperative Care - methods</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>ROC Curve</topic><topic>Spectroscopy, Near-Infrared</topic><topic>Survivors</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hansen, Jan H., MD</creatorcontrib><creatorcontrib>Rotermann, Ina, PsyM</creatorcontrib><creatorcontrib>Logoteta, Jana, MD</creatorcontrib><creatorcontrib>Jung, Olaf, MD</creatorcontrib><creatorcontrib>Dütschke, Peter, MD</creatorcontrib><creatorcontrib>Scheewe, Jens, MD</creatorcontrib><creatorcontrib>Kramer, Hans-Heiner, MD, PhD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hansen, Jan H., MD</au><au>Rotermann, Ina, PsyM</au><au>Logoteta, Jana, MD</au><au>Jung, Olaf, MD</au><au>Dütschke, Peter, MD</au><au>Scheewe, Jens, MD</au><au>Kramer, Hans-Heiner, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Neurodevelopmental outcome in Hypoplastic left heart syndrome – impact of perioperative cerebral tissue oxygenation of the Norwood procedure</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2016-05-01</date><risdate>2016</risdate><volume>151</volume><issue>5</issue><spage>1358</spage><epage>1366</epage><pages>1358-1366</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><abstract>Objectives Patients with hypoplastic left heart syndrome are at risk for neurodevelopmental impairment. Hypoxic-ischemic brain injury during neonatal treatment might be a relevant cause. We evaluated the association between cerebral oxygenation in the perioperative course of the Norwood procedure and neurodevelopmental outcome. Methods Cerebral tissue oxygen saturation (ScO2) was obtained by near-infrared spectroscopy for 24 hours before and 48 hours after surgery in 43 patients. Full scale, verbal and performance IQ were evaluated with the Wechsler Preschool and Primary Scale of Intelligence at 4.5 (3.5-6.8) years. Cognitive functions were assessed with the German “Kognitiver Entwicklungstest für das Kindergartenalter” (KET-KID). Results IQ scores and KET-KID percentile ranks were in the lower normal range (Full scale IQ: 94 ±11, verbal IQ: 97 ±13, performance IQ: 93 ±9; KET-KID global: 42 ±27, verbal: 48 ±29, nonverbal: 37 ±23). Scores were below average (Full scale IQ <85 or KET-KID <16th percentile) in 12 cases. Preoperative ScO2 was lower in patients scoring below average (56.8 ±7.1% vs. 61.7 ±5.8%, p=0.028) and correlated with full scale IQ (r=0.495, p=0.001), verbal IQ (r=0.524, p=0.001), performance IQ (r=0.386, p=0.012) and with global (r=0.360, p=0.018) and verbal (r=0.395, p=0.009) KET-KID scores. A relationship between IQ or KET-KID scores and postoperative ScO2 was not found. Gestational age, head circumference z-score, age at surgery and postoperative length of stay were associated with IQ and KET-KID scores. Conclusions Neurodevelopmental outcome was in the lower normal range. Besides innate patient factors, preoperative cerebral tissue oxygenation is likely an important determinant of cognitive development.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27085616</pmid><doi>10.1016/j.jtcvs.2016.02.035</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Area Under Curve Cardiothoracic Surgery Cerebrovascular Circulation Child Child, Preschool Cognition Disorders - epidemiology Cognition Disorders - etiology Cognition Disorders - physiopathology Cohort Studies Developmental Disabilities - epidemiology Developmental Disabilities - etiology Developmental Disabilities - physiopathology Female Follow-Up Studies Humans Hypoplastic Left Heart Syndrome - complications Hypoplastic Left Heart Syndrome - surgery hypoplastic left heart syndrome, developmental outcome, near-infrared spectroscopy Hypoxia-Ischemia, Brain - etiology Hypoxia-Ischemia, Brain - physiopathology Hypoxia-Ischemia, Brain - psychology Male Neuropsychological Tests Norwood Procedures - adverse effects Norwood Procedures - methods Oxygen Consumption - physiology Palliative Care - methods Perioperative Care - methods Retrospective Studies Risk Assessment ROC Curve Spectroscopy, Near-Infrared Survivors Time Factors Treatment Outcome |
| title | Neurodevelopmental outcome in Hypoplastic left heart syndrome – impact of perioperative cerebral tissue oxygenation of the Norwood procedure |
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