title: The impact of cerebral embolization during infant cardiac surgery on neurodevelopmental outcomes at intermediate follow-up.
abstract: Cerebral embolization during pediatric cardiac surgery may be an underappreciated source of subsequent neurodevelopmental impairment. Transcranial Doppler ultrasound is a neuromonitoring tool that can provide intraoperative surveillance for cerebral embolization. We hypothesized that increased cerebral embolic signals detected during infant cardiac surgery would be associated with worse neurodevelopmental outcomes at follow-up. A study group of 24 children who underwent infant cardiac surgery with transcranial Doppler detection of cerebral embolic signals returned at intermediate follow-up for standardized neurodevelopmental assessment. The children were evaluated using two neurocognitive tests and the parents completed two questionnaires regarding observed behavior. Statistical analysis assessed for correlation between the number of cerebral embolic signals at surgery and the results of the neurodevelopmental assessment. Of the 67 test parameters analyzed, five showed a significant association with the number of embolic signals, yet, all in the contrary direction of the clinical hypothesis, likely representing a Type I error. Thus, in this small cohort of patients, the number of cerebral embolic signals detected during infant cardiac surgery was not shown to be associated with worse neurodevelopmental outcomes at intermediate follow-up. A larger study is probably necessary to ascertain the potential influence of cerebral embolic signals on eventual neurologic outcomes in children. The clinical relevance of cerebral embolic signals during pediatric cardiac surgery remains undetermined and deserves further investigation.
authors.affiliation: Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Naik
authors.affiliation: Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: Wagner
authors.affiliation: Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA.
authors.forename: D
authors.initials: D
authors.lastname: Chowdhury
authors.affiliation: Impulse Monitoring Inc., Columbia, Maryland, USA.
authors.forename: M l
authors.initials: Ml
authors.lastname: Barnes
authors.affiliation: Department of Neurology, Penn State College of Medicine, Hershey, Pennsylvania, USA.
authors.forename: D S
authors.initials: DS
authors.lastname: Wagner
authors.affiliation: Department of Neurology, Penn State College of Medicine, Hershey, Pennsylvania, USA.
authors.forename: K C
authors.initials: KC
authors.lastname: Burson
authors.affiliation: Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA Department of Neurology, Penn State College of Medicine, Hershey, Pennsylvania, USA.
authors.forename: P J
authors.initials: PJ
authors.lastname: Eslinger
authors.affiliation: Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA Department of Surgery, Penn State College of Medicine, Hershey, Pennsylvania, USA jclark7@hmc.psu.edu.
authors.forename: J B
authors.initials: JB
authors.lastname: Clark
mesh_terms: D006348:Cardiac Surgical Procedures; D002560:Cerebrovascular Circulation; D002657:Child Development; D003071:Cognition; D004621:Embolization, Therapeutic; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017585:Ultrasonography, Doppler, Transcranial
keywords: brain; congenital; embolization; neurodevelopmental; neuromonitoring; pediatric; transcranial Doppler