title: Non-invasive Assessment of Cerebral Blood Flow and Oxygen Metabolism in Neonates during Hypothermic Cardiopulmonary Bypass: Feasibility and Clinical Implications.
abstract: The neonatal brain is extremely vulnerable to injury during periods of hypoxia and/or ischemia. Risk of brain injury is increased during neonatal cardiac surgery, where pre-existing hemodynamic instability and metabolic abnormalities are combined with long periods of low cerebral blood flow and/or circulatory arrest. Our understanding of events associated with cerebral hypoxia-ischemia during cardiopulmonary bypass (CPB) remains limited, largely due to inadequate tools to quantify cerebral oxygen delivery and consumption non-invasively and in real-time. This pilot study aims to evaluate cerebral blood flow (CBF) and oxygen metabolism (CMRO2) intraoperatively in neonates by combining two novel non-invasive optical techniques: frequency-domain near-infrared spectroscopy (FD-NIRS) and diffuse correlation spectroscopy (DCS). CBF and CMRO2were quantified before, during and after deep hypothermic cardiopulmonary bypass (CPB) in nine neonates. Our results show significantly decreased CBF and CMRO2during hypothermic CPB. More interestingly, a change of coupling between both variables is observed during deep hypothermic CPB in all subjects. Our results are consistent with previous studies using invasive techniques, supporting the concept of FD-NIRS/DCS as a promising technology to monitor cerebral physiology in neonates providing the potential for individual optimization of surgical management.
authors.affiliation: Fetal-Neonatal Neuroimaging &Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Silvina L
authors.initials: SL
authors.lastname: Ferradal
authors.affiliation: Department of Anesthesiology, Perioperative &Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Koichi
authors.initials: K
authors.lastname: Yuki
authors.affiliation: Fetal-Neonatal Neuroimaging &Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Rutvi
authors.initials: R
authors.lastname: Vyas
authors.affiliation: Fetal-Neonatal Neuroimaging &Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Ha
authors.affiliation: Fetal-Neonatal Neuroimaging &Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Francesca
authors.initials: F
authors.lastname: Yi
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Stopp
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: David
authors.initials: D
authors.lastname: Wypij
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Henry H
authors.initials: HH
authors.lastname: Cheng
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Jane W
authors.initials: JW
authors.lastname: Newburger
authors.affiliation: Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Aditya K
authors.initials: AK
authors.lastname: Kaza
authors.affiliation: Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Franceschini
authors.affiliation: Department of Anesthesiology, Perioperative &Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Barry D
authors.initials: BD
authors.lastname: Kussman
authors.affiliation: Fetal-Neonatal Neuroimaging &Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: P Ellen
authors.initials: PE
authors.lastname: Grant
mesh_terms: D002315:Cardiopulmonary Bypass; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D007231:Infant, Newborn; D008297:Male; D010100:Oxygen / Q000378:metabolism*
chemical_list: D010100:Oxygen