title: Neurodevelopmental outcome in hypoplastic left heart syndrome: Impact of perioperative cerebral tissue oxygenation of the Norwood procedure.
abstract: OBJECTIVE
  Patients with hypoplastic left heart syndrome are at risk for neurodevelopmental impairment. Hypoxic-ischemic brain injury during neonatal treatment might be a relevant cause. We evaluated the association between cerebral oxygenation in the perioperative course of the Norwood procedure and neurodevelopmental outcome.
  
  
  METHODS
  Cerebral tissue oxygen saturation (ScO2) was obtained by near-infrared spectroscopy for 24 hours before and 48 hours after surgery in 43 patients. Full-scale, verbal, and performance IQ scores were evaluated with the Wechsler Preschool and Primary Scale of Intelligence at a median of 4.5 years (range, 3.5-6.8 years). Cognitive functions were assessed with the German Kognitiver Entwicklungstest für das Kindergartenalter (KET-KID).
  
  
  RESULTS
  Mean IQ scores and KET-KID percentile ranks were in the lower-normal range (full-scale IQ, 94 ± 11; verbal IQ, 97 ± 13; performance IQ, 93 ± 9; KET-KID global, 42 ± 27; verbal, 48 ± 29; nonverbal, 37 ± 23). Scores were below average (full scale IQ <85 or KET-KID <16th percentile) in 12 cases. Mean preoperative ScO2 was lower in patients scoring below average (56.8% ± 7.1% vs 61.7% ± 5.8%; P = .028) and was correlated with full-scale IQ (r = 0.495; P = .001), verbal IQ (r = 0.524; P = .001), and performance IQ (r = 0.386; P = .012) scores, and with global (r = 0.360; P = .018) and verbal (r = 0.395, P = .009) KET-KID scores. A relationship between IQ or KET-KID scores and postoperative ScO2 was not found. Gestational age, head circumference z-score, age at surgery, and postoperative length of stay were associated with IQ and KET-KID scores.
  
  
  CONCLUSIONS
  Neurodevelopmental outcome was in the lower-normal range. Along with innate patient factors, preoperative cerebral tissue oxygenation is likely an important determinant of cognitive development.
authors.affiliation: Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany. Electronic address: jan.hansen@uk-sh.de.
authors.forename: Jan H
authors.initials: JH
authors.lastname: Hansen
authors.affiliation: Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany.
authors.forename: Ina
authors.initials: I
authors.lastname: Rotermann
authors.affiliation: Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany.
authors.forename: Jana
authors.initials: J
authors.lastname: Logoteta
authors.affiliation: Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany.
authors.forename: Olaf
authors.initials: O
authors.lastname: Jung
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Dütschke
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Scheewe
authors.affiliation: Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany.
authors.forename: Hans-Heiner
authors.initials: HH
authors.lastname: Kramer
mesh_terms: D019540:Area Under Curve; D002560:Cerebrovascular Circulation; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D015331:Cohort Studies; D002658:Developmental Disabilities / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000150:complications / Q000601:surgery*; D020925:Hypoxia-Ischemia, Brain / Q000209:etiology / Q000503:physiopathology* / Q000523:psychology; D008297:Male; D009483:Neuropsychological Tests; D058327:Norwood Procedures / Q000009:adverse effects / Q000379:methods*; D010101:Oxygen Consumption / Q000502:physiology*; D010166:Palliative Care / Q000379:methods; D019990:Perioperative Care / Q000379:methods; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D019265:Spectroscopy, Near-Infrared; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome
keywords: hypoplastic left heart syndrome, developmental outcome, near-infrared spectroscopy