Periventricular leukomalacia is common after neonatal cardiac surgery.
OBJECTIVE
Periventricular leukomalacia is necrosis of the cerebral white matter adjacent to the lateral ventricles and results from injury to immature oligodendroglia. In infants without congenital heart disease, periventricular leukomalacia is associated with an increased incidence of developmental delay and attention deficit/hyperactivity disorder. The incidence of periventricular leukomalacia and the risk factors for development of periventricular leukomalacia after infant cardiac surgery are not known.


METHODS
Magnetic resonance imaging of the brain was performed 6 to 14 days after cardiac surgery utilizing cardiopulmonary bypass with or without deep hypothermic circulatory arrest in 105 neonates and infants < or = 6 months of age.


RESULTS
Median age at surgery was 6 days (range 1-178), with 82 neonates (age < or = 30 days). Periventricular leukomalacia was found in 44 of the neonates (54%) compared with 1 of 23 infants (4%). Forward logistic regression using age at surgery as a continuous variable identified a model containing longer total support time (cardiopulmonary bypass plus deep hypothermic circulatory arrest), lower systolic blood pressure at cardiac intensive care unit admission postoperatively, lower minimum diastolic blood pressure, and Po(2) in the first 48 hours after surgery. When age at surgery was considered as a dichotomous variable (neonate versus infant), younger age at surgery replaced systolic blood pressure, Po(2), and total support time in the model. Lower minimum diastolic blood pressure was a significant risk factor in both models.


CONCLUSIONS
Periventricular leukomalacia was found in >50% of neonates after cardiac surgery but rarely in older infants. Hypoxemia and hypotension in the early postoperative period, particularly diastolic hypotension, may be important risk factors for periventricular leukomalacia.
Division of Cardiothoracic Anesthesiology, The Cardiac Center, Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA.
Kristin K
KK
Galli
Robert A
RA
Zimmerman
Gail P
GP
Jarvik
Gil
G
Wernovsky
Marijn K
MK
Kuypers
Robert R
RR
Clancy
Lisa M
LM
Montenegro
William T
WT
Mahle
Mark F
MF
Newman
Ann M
AM
Saunders
Susan C
SC
Nicolson
Thomas L
TL
Spray
J William
JW
Gaynor
Kristen K
KK
Galli
D001057:Apolipoproteins E / Q000235:genetics; D001794:Blood Pressure; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass; D005260:Female; D005838:Genotype; D006330:Heart Defects, Congenital / Q000235:genetics / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007969:Leukomalacia, Periventricular / Q000175:diagnosis / Q000209:etiology*; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D010100:Oxygen / Q000097:blood; D012307:Risk Factors
D001057:Apolipoproteins E; D010100:Oxygen