title: Time to surgery and preoperative cerebral hemodynamics predict postoperative white matter injury in neonates with hypoplastic left heart syndrome.
abstract: OBJECTIVE
  Hypoxic-ischemic white mater brain injury commonly occurs in neonates with hypoplastic left heart syndrome (HLHS). Approximately one half of HLHS survivors will exhibit neurobehavioral symptoms believed to be associated with this injury, although the exact timing of the injury is unknown.
  
  
  METHODS
  Neonates with HLHS were recruited for pre- and postoperative monitoring of cerebral oxygen saturation, cerebral oxygen extraction fraction, and cerebral blood flow using 2 noninvasive optical-based techniques: diffuse optical spectroscopy and diffuse correlation spectroscopy. Anatomic magnetic resonance imaging was performed before and approximately 1 week after surgery to quantify the extent and timing of the acquired white matter injury. The risk factors for developing new or worsened white matter injury were assessed using uni- and multivariate logistic regression.
  
  
  RESULTS
  A total of 37 neonates with HLHS were studied. On univariate analysis, neonates who developed a large volume of new, or worsened, postoperative white matter injury had a significantly longer time to surgery (P=.0003). In a multivariate model, a longer time between birth and surgery, delayed sternal closure, and greater preoperative cerebral blood flow were predictors of postoperative white matter injury. Additionally, a longer time to surgery and greater preoperative cerebral blood flow on the morning of surgery correlated with lower cerebral oxygen saturation (P=.03 and P=.05, respectively) and greater oxygen extraction fraction (P=.05 for both).
  
  
  CONCLUSIONS
  A longer time to surgery was associated with new postoperative white matter injury in otherwise healthy neonates with HLHS. The results suggest that earlier Norwood palliation might decrease the likelihood of acquiring postoperative white matter injury.
authors.affiliation: Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pa. Electronic address: jenlynch@alumni.upenn.edu.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Lynch
authors.affiliation: Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pa; Athinoula A. Martinos Center for Biomedical Imaging, Optics Division, Massachusetts General Hospital, Charlestown, Mass; Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pa.
authors.forename: Erin M
authors.initials: EM
authors.lastname: Buckley
authors.affiliation: Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pa.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Schwab
authors.affiliation: Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pa.
authors.forename: Ann L
authors.initials: AL
authors.lastname: McCarthy
authors.affiliation: Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pa.
authors.forename: Madeline E
authors.initials: ME
authors.lastname: Winters
authors.affiliation: Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pa.
authors.forename: David R
authors.initials: DR
authors.lastname: Busch
authors.affiliation: Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Rui
authors.initials: R
authors.lastname: Xiao
authors.affiliation: Division of Pediatric Cardiology, Loma Linda University Children's Hospital, Loma Linda, Calif.
authors.forename: Donna A
authors.initials: DA
authors.lastname: Goff
authors.affiliation: Division of Cardiothoracic Anesthesia, The Children's Hospital of Philadelphia, Philadelphia, Pa.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Nicolson
authors.affiliation: Division of Cardiothoracic Anesthesia, The Children's Hospital of Philadelphia, Philadelphia, Pa.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Montenegro
authors.affiliation: Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pa.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Fuller
authors.affiliation: Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pa.
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
authors.affiliation: Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pa.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Spray
authors.affiliation: Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Arjun G
authors.initials: AG
authors.lastname: Yodh
authors.affiliation: Division of Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pa.
authors.forename: Maryam Y
authors.initials: MY
authors.lastname: Naim
authors.affiliation: Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pa.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Licht
mesh_terms: D015415:Biomarkers / Q000097:blood; D002560:Cerebrovascular Circulation; D005260:Female; D006439:Hemodynamics; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D007231:Infant, Newborn; D056784:Leukoencephalopathies / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D015999:Multivariate Analysis; D058327:Norwood Procedures / Q000009:adverse effects*; D010100:Oxygen / Q000097:blood; D010166:Palliative Care; D065840:Protective Factors; D012307:Risk Factors; D019265:Spectroscopy, Near-Infrared; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D010100:Oxygen
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