title: Neurodevelopmental outcome after cardiac surgery utilizing cardiopulmonary bypass in children.
abstract: BACKGROUND
  Modulating the stress response and perioperative factors can have a paramount impact on the neurodevelopmental outcome of infants who undergo cardiac surgery utilizing cardiopulmonary bypass.
  
  
  METHODS
  In this single center prospective follow-up study, we evaluated the impact of three different anesthetic techniques on the neurodevelopmental outcomes of 19 children who previously underwent congenital cardiac surgery within their 1(st) year of life. Cases were done from May 2011 to December 2013. Children were assessed using the Stanford-Binet Intelligence Scales (5(th) edition). Multiple regression analysis was used to test different parental and perioperative factors that could significantly predict the different neurodevelopmental outcomes in the entire cohort of patients.
  
  
  RESULTS
  When comparing the three groups regarding the major cognitive scores, a high-dose fentanyl (HDF) patients scored significantly higher than the low-dose fentanyl (LDF) + dexmedetomidine (DEX) (LDF + DEX) group in the quantitative reasoning scores (106 ± 22 vs. 82 ± 15 P = 0.046). The bispectral index (BIS) value at the end of surgery for the -LDF group was significantly higher than that in LDF + DEX group (P = 0.011). For the entire cohort, a strong correlation was seen between the standard verbal intelligence quotient (IQ) score and the baseline adrenocorticotropic hormone level, the interleukin-6 level at the end of surgery and the BIS value at the end of the procedure with an R(2) value of 0.67 and P < 0.04. There was an inverse correlation between the cardiac Intensive Care Unit length of stay and the full-scale IQ score (R = 0.4675 and P 0.027).
  
  
  CONCLUSIONS
  Patients in the HDF group demonstrated overall higher neurodevelopmental scores, although it did not reach statistical significance except in fluid reasoning scores. Our results may point to a possible correlation between blunting the stress response and improvement of the neurodevelopmental outcome.
authors.affiliation: Department of Anesthesiology, Section of Critical Care Medicine, College of Medicine, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA ; The Heart Center, Section of Critical Care Medicine, College of Medicine, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA.
authors.forename: Aymen N
authors.initials: AN
authors.lastname: Naguib
authors.affiliation: Department of Anesthesiology, Section of Critical Care Medicine, College of Medicine, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA ; The Heart Center, Section of Critical Care Medicine, College of Medicine, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Winch
authors.affiliation: Department of Anesthesiology, Section of Critical Care Medicine, College of Medicine, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA ; The Heart Center, Section of Critical Care Medicine, College of Medicine, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
authors.affiliation: Department of Pediatrics, Section of Critical Care Medicine, College of Medicine, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA.
authors.forename: Keith O
authors.initials: KO
authors.lastname: Yeates
authors.affiliation: The Heart Center, Section of Critical Care Medicine, College of Medicine, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA.
authors.forename: Yongjie
authors.initials: Y
authors.lastname: Miao
authors.affiliation: The Heart Center, Section of Critical Care Medicine, College of Medicine, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Galantowicz
authors.affiliation: The Heart Center, Section of Critical Care Medicine, College of Medicine, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Hoffman
keywords: Anesthesia and neurotoxicity; neurodevelopmental outcomes; pediatric cardiac surgery; role of anesthetics in modulating the stress response; stress response