Developmental and neurologic effects of alpha-stat versus pH-stat strategies for deep hypothermic cardiopulmonary bypass in infants.
OBJECTIVE
In a randomized single-center trial, we compared developmental and neurologic outcomes at 1 and 2 to 4 years of age in children who underwent reparative cardiac operations at less than 9 months of age after use of the alpha-stat versus pH-stat strategy during deep hypothermic cardiopulmonary bypass.


METHODS
Among 168 children eligible for follow-up, 1-year developmental evaluations were carried out on 111, neurologic evaluations on 110, and electroencephalographic evaluations on 102. Parents of 122 children completed questionnaires on behavior and development when children were 2 to 4 years of age.


RESULTS
The Psychomotor Development Index scores of the alpha-stat and pH-stat groups did not differ significantly (P =.97). For Mental Development Index scores, the treatment group effect differed according to diagnosis (P =.007). In the D -transposition of the great arteries (n = 59) and tetralogy of Fallot (n = 36) subgroups, the pH-stat group had slightly higher Mental Development Index scores than the alpha-stat group, although these differences were not statistically significant. In the ventricular septal defect subgroup (n = 16), the alpha-stat group had significantly higher scores. Psychomotor Development Index and Mental Development Index scores were significantly higher in the group with D -transposition of the great arteries than in the other 2 groups (P =.03 and P =.01, respectively). Across all diagnoses, Mental Development Index scores were significantly higher than Psychomotor Development Index scores (P <.001). Treatment group assignment was not significantly associated with abnormalities on neurologic examination (P =.70) or electroencephalographic examination (P =.77) at 1 year or with parents' ratings of children's development (P =.99) or behavior (P =.27) at age 2 to 4 years.


CONCLUSIONS
Use of alpha-stat versus pH-stat acid-base management strategy during reparative infant cardiac operations with deep hypothermic cardiopulmonary bypass was not consistently related to either improved or impaired early neurodevelopmental outcomes.
Bellinger
D C
DC
Department of Neurology, Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA.
Wypij
D
D
du Plessis
A J
AJ
Rappaport
L A
LA
Riviello
J
J
Jonas
R A
RA
Newburger
J W
JW
D001831:Body Temperature; D002245:Carbon Dioxide / Q000097:blood*; D002652:Child Behavior; D002657:Child Development; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D004569:Electroencephalography; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000097:blood / Q000601:surgery; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000379:methods*; D007223:Infant; D008297:Male; D009460:Neurologic Examination; D011446:Prospective Studies; D013771:Tetralogy of Fallot / Q000097:blood / Q000601:surgery; D014188:Transposition of Great Vessels / Q000097:blood / Q000601:surgery
D002245:Carbon Dioxide