Oxygen saturations and neurodevelopmental outcomes in single ventricle heart disease

• Published in: Pediatric pulmonology Vol. 54; no. 6; pp. 922 - 927
• Main Authors: Wolfe, Kelly R., Brinton, John, Di Maria, Michael V., Meier, Maxene, Liptzin, Deborah R.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.06.2019
• Subjects: blood oxygenation; Cardiovascular disease; Female; Heart Defects, Congenital - complications; Heart Defects, Congenital - surgery; Humans; Hypoxia; Infant; Infant, Newborn; Longitudinal Studies; Male; neurodevelopment; Neurodevelopmental Disorders - diagnosis; Neurodevelopmental Disorders - prevention & control; Oximetry; Oxygen - adverse effects; Oxygen - therapeutic use; Patient Discharge; pediatric heart network; Postoperative Period; Psychomotor Disorders - diagnosis; Psychomotor Disorders - prevention & control; pulse oximetry; Regression Analysis; Retrospective Studies; Risk; single ventricle; Surgery; Treatment Outcome; Univentricular Heart - complications; Univentricular Heart - surgery; pulse oximetry; pediatric heart network; neurodevelopment; single ventricle; blood oxygenation
• DOI: 10.1002/ppul.24275
• ISSN: 8755-6863; 1099-0496

Objectives To evaluate whether the degree of hypoxemia following stage‐I and stage‐II palliative surgeries predicts neurodevelopmental outcomes at 14 months of age in children with single ventricle congenital heart disease (SVCHD). Design We analyzed longitudinal data from two Pediatric Heart Network (PHN) randomized controlled trials, with a total of 328 subjects. Oxygen saturations, measured via pulse oximetry, at time of discharge from stage‐I and stage‐II surgeries were the primary predictors of interest, and Bayley Scales of Infant Development‐II (BSID‐II) scores at 14 months old were the primary outcome measure. Relevant covariates from previously‐published PHN studies were also included in regression models. Results Oxygen saturations at time of discharge from stage‐I and stage‐II surgeries were not related to BSID‐II scores. Having one or more oxygen saturation measurements below 80% was also not associated with BSID‐II scores, and neither was change in oxygen saturations over time. These relationships were not altered by inclusion of relevant covariates. Conclusions In this large cohort of children with SVCHD, oxygen saturations post‐stage‐I and post‐stage‐II palliation surgeries as measured via pulse oximetry were not associated with neurodevelopmental outcomes at 14 months of age. The relationship between oxygen saturations and neurodevelopment in SVCHD is likely complex, and neurodevelopment is known to be affected by a number of factors. Pulse oximetry may also be an insufficient proxy for cerebral oxygen delivery. Clinically, pulse oximetry readings during the interstage and post‐stage‐II surgery periods are not a reliable predictor of future neurodevelopmental risk.