title: Infection and white matter injury in infants with congenital cardiac disease.
abstract: More than 60% of newborns with severe congenital cardiac disease develop perioperative brain injuries. Known risk factors include: pre-operative hypoxemia, cardiopulmonary bypass characteristics, and post-operative hypotension. Infection is an established risk factor for white matter injury in premature newborns. In this study, we examined term infants with congenital cardiac disease requiring surgical repair to determine whether infection is associated with white matter injury. Acquired infection was specified by site - bloodstream, pneumonia, or surgical site infection - according to strict definitions. Infection was present in 23 of 127 infants. Pre- and post-operative imaging was evaluated for acquired injury by a paediatric neuroradiologist. Overall, there was no difference in newly acquired post-operative white matter injury in infants with infection (30%), compared to those without (31%). When stratified by anatomy, infants with transposition of the great arteries, and bloodstream infection had an estimated doubling of risk of white matter injury that was not significant, whereas those with single ventricle anatomy had no apparent added risk. When considering only infants without stroke, the estimated association was higher, and became significant after adjusting for duration of inotrope therapy. In this study, nosocomial infection was not associated with white matter injury. Nonetheless, when controlling for risk factors, there was an association between bloodstream infection and white matter injury in selected sub-populations. Infection prevention may have the potential to mitigate long-term neurologic impairment as a consequence of white matter injury, which underscores the importance of attention to infection control for these patients.
authors.affiliation: Department of Neurology, University of California, San Francisco, United States of America. Hannah.Glass@ucsf.edu
authors.forename: Hannah C
authors.initials: HC
authors.lastname: Glass
authors.forename: Chelsea
authors.initials: C
authors.lastname: Bowman
authors.forename: Vann
authors.initials: V
authors.lastname: Chau
authors.forename: Alisha
authors.initials: A
authors.lastname: Moosa
authors.forename: Adam L
authors.initials: AL
authors.lastname: Hersh
authors.forename: Andrew
authors.initials: A
authors.lastname: Campbell
authors.forename: Kenneth
authors.initials: K
authors.lastname: Poskitt
authors.forename: Anthony
authors.initials: A
authors.lastname: Azakie
authors.forename: A James
authors.initials: AJ
authors.lastname: Barkovich
authors.forename: Steven P
authors.initials: SP
authors.lastname: Miller
authors.forename: Patrick S
authors.initials: PS
authors.lastname: McQuillen
mesh_terms: D003428:Cross Infection / Q000150:complications*; D005260:Female; D006331:Heart Diseases / Q000150:complications* / Q000151:congenital* / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007969:Leukomalacia, Periventricular / Q000175:diagnosis / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies