The association between brain injury, perioperative anesthetic exposure, and 12-month neurodevelopmental outcomes after neonatal cardiac surgery: a retrospective cohort study.
BACKGROUND
Adverse neurodevelopmental outcomes are observed in up to 50% of infants after complex cardiac surgery. We sought to determine the association of perioperative anesthetic exposure with neurodevelopmental outcomes at age 12 months in neonates undergoing complex cardiac surgery and to determine the effect of brain injury determined by magnetic resonance imaging (MRI).


METHODS
Retrospective cohort study of neonates undergoing complex cardiac surgery who had preoperative and 7-day postoperative brain MRI and 12-month neurodevelopmental testing with Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). Doses of volatile anesthetics (VAA), benzodiazepines, and opioids were determined during the first 12 months of life.


RESULTS
From a database of 97 infants, 59 met inclusion criteria. Mean ± sd composite standard scores were as follows: cognitive = 102.1 ± 13.3, language = 87.8 ± 12.5, and motor = 89.6 ± 14.1. After forward stepwise multivariable analysis, new postoperative MRI injury (P = 0.039) and higher VAA exposure (P = 0.028) were associated with lower cognitive scores. ICU length of stay (independent of brain injury) was associated with lower performance on all categories of the Bayley-III (P < 0.02).


CONCLUSIONS
After adjustment for multiple relevant covariates, we demonstrated an association between VAA exposure, brain injury, ICU length of stay, and lower neurodevelopmental outcome scores at 12 months of age. These findings support the need for further studies to identify potential modifiable factors in the perioperative care of neonates with CHD to improve neurodevelopmental outcomes.
Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Pediatric Cardiovascular Anesthesiology, Texas Children's Hospital, Houston, TX, USA.
Dean B
DB
Andropoulos
Hasan B
HB
Ahmad
Taha
T
Haq
Ken
K
Brady
Stephen A
SA
Stayer
Marcie R
MR
Meador
Jill V
JV
Hunter
Carlos
C
Rivera
Robert G
RG
Voigt
Marie
M
Turcich
Cathy Q
CQ
He
Lara S
LS
Shekerdemian
Heather A
HA
Dickerson
Charles D
CD
Fraser
E
E
Dean McKenzie
Jeffrey S
JS
Heinle
R
R
Blaine Easley
D000777:Anesthetics / Q000008:administration & dosage / Q000009:adverse effects*; D001921:Brain / Q000473:pathology; D001927:Brain Diseases / Q000139:chemically induced* / Q000473:pathology / Q000523:psychology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass; D015331:Cohort Studies; D002658:Developmental Disabilities / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D006330:Heart Defects, Congenital / Q000523:psychology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects; D007223:Infant; D007231:Infant, Newborn; D007805:Language Development Disorders / Q000139:chemically induced / Q000453:epidemiology; D008279:Magnetic Resonance Imaging; D008297:Male; D009420:Nervous System / Q000187:drug effects / Q000254:growth & development*; D009483:Neuropsychological Tests; D059035:Perioperative Period; D012189:Retrospective Studies
D000777:Anesthetics; D006993:Hypnotics and Sedatives
congenital heart disease; general anesthesia; inhaled agents; intravenous agents; neonate; neurodevelopment