title: Systemic venous oxygen saturation after the Norwood procedure and childhood neurodevelopmental outcome.
abstract: OBJECTIVE
  Neonates with hypoplastic left heart syndrome have impaired systemic oxygen delivery and also have a high risk of hypoxic ischemic brain injury with resultant neurodevelopmental impairment. We hypothesized that decreased postoperative oxygen delivery, as measured on the basis of systemic venous oxyhemoglobin saturation, would be related to persistent neurodevelopmental abnormality assessed in childhood.
  
  
  METHODS
  Early perioperative hemodynamic data, prospectively acquired from neonates undergoing staged palliation of hypoplastic left heart syndrome by using deep hypothermic circulatory arrest with uniform perioperative management, were tested for relationship to later neurodevelopmental outcome assessed at age 4 years.
  
  
  RESULTS
  Complete hemodynamic and neurodevelopmental data were available in 13 patients aged 7 +/- 8 days at the time of the Norwood procedure and aged 4.5 +/- 0.7 years at follow-up assessment. The subjects scored significantly below the population mean for motor, visual-motor integration, and composite neurodevelopmental outcomes. The 5 (38%) patients with abnormal outcomes had significantly lower postoperative systemic venous oxygen saturation values than those with normal outcomes (46% +/- 8% vs 56% +/- 6%, P = .024). Standard hemodynamic parameters did not differentiate patient outcomes. The risk of abnormal outcome increased with increasing time at a systemic venous oxygen saturation of less than 40% (P < .001). A multivariate model of deep hypothermic circulatory arrest time, systemic venous oxygen saturation, blood pressure, and carbon dioxide tension accounted for 79% of the observed variance (P < .001).
  
  
  CONCLUSIONS
  Decreased systemic oxygen delivery in the neonatal postoperative period is associated with hypoxic-ischemic brain injury and childhood neurodevelopmental abnormality. Measures of systemic oxygen delivery should be used to guide perioperative strategies to reduce the risk of hypoxic-ischemic brain injury.
authors.affiliation: Department of Pediatric Anesthesiology, Medical College of Wisconsin, Milwaukee, Wis, USA. ghoffman@mcw.edu
authors.forename: George M
authors.initials: GM
authors.lastname: Hoffman
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Mussatto
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Brosig
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Ghanayem
authors.forename: Ndidiamaka
authors.initials: N
authors.lastname: Musa
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Fedderly
authors.forename: Robert D B
authors.initials: RD
authors.lastname: Jaquiss
authors.forename: James S
authors.initials: JS
authors.lastname: Tweddell
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods; D002657:Child Development; D002675:Child, Preschool; D003071:Cognition; D006439:Hemodynamics; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000378:metabolism* / Q000503:physiopathology / Q000601:surgery*; D007231:Infant, Newborn; D009048:Motor Skills; D010100:Oxygen / Q000097:blood / Q000378:metabolism*; D011446:Prospective Studies
chemical_list: D010100:Oxygen