title: Near-infrared spectroscopy in neonates before palliation of hypoplastic left heart syndrome.
abstract: BACKGROUND
  Neonates with hypoplastic left heart syndrome have circulatory vulnerability that results in shock and high risk of mortality without intervention. High arterial saturation (SaO(2)) is often used as a proxy for inadequate systemic oxygen delivery and triggers the use of invasive therapies to restore circulatory balance. We hypothesized that preoperative use of near-infrared spectroscopy (NIRS) would reduce the need for invasive therapies, including controlled ventilation and inspired gas manipulation.
  
  
  METHODS
  A Human Research Review Board-approved retrospective review of patients who had stage 1 palliation from January 2000 to January 2006 was conducted. Preoperative patient characteristics, cardiorespiratory support, and monitored data were collected for all patients. Cerebral and somatic tissue oxyhemoglobin saturations were recorded for patients with preoperative NIRS monitoring.
  
  
  RESULTS
  The studied cohort included 92 patients, 47 without and 45 with preoperative NIRS. Patient characteristics were similar between groups. Differences were observed in preoperative respiratory support. Controlled ventilation was less common in the NIRS group (51% versus 79%, p = 0.005) as was the use of inspired nitrogen (16% versus 70%, p = 0.001). The NIRS patients had higher mean SaO(2) (92% versus 88%, p = 0.001). Age at surgery was similar between groups (5.7 +/- 3.2 versus 6.5 +/- 5.2 days, p = 0.3). Early survival was 96% in each group.
  
  
  CONCLUSIONS
  Near-infrared spectroscopy monitoring of patients with hypoplastic left heart syndrome awaiting palliation provides noninvasive assessment of oxygen delivery and simplified management, with reduced use of controlled ventilation and inspired gas. Higher SaO(2) in the NIRS group was not associated with impaired systemic oxygen delivery, and did not lead to earlier palliation or postoperative mortality.
authors.affiliation: Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wisconsin 53226, USA.
authors.forename: Beth Ann
authors.initials: BA
authors.lastname: Johnson
authors.forename: George M
authors.initials: GM
authors.lastname: Hoffman
authors.forename: James S
authors.initials: JS
authors.lastname: Tweddell
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Cava
authors.forename: Mir
authors.initials: M
authors.lastname: Basir
authors.forename: Michael E
authors.initials: ME
authors.lastname: Mitchell
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Scanlon
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Mussatto
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Ghanayem
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D007231:Infant, Newborn; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D010166:Palliative Care / Q000379:methods*; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D019265:Spectroscopy, Near-Infrared / Q000379:methods*; D015996:Survival Rate; D013997:Time Factors