The association between brain injury, perioperative anesthetic exposure, and 12-month neurodevelopmental outcomes after neonatal cardiac surgery: a retrospective cohort study

• Published in: Pediatric anesthesia Vol. 24; no. 3; pp. 266 - 274
• Main Authors: Andropoulos, Dean B., Ahmad, Hasan B., Haq, Taha, Brady, Ken, Stayer, Stephen A., Meador, Marcie R., Hunter, Jill V., Rivera, Carlos, Voigt, Robert G., Turcich, Marie, He, Cathy Q., Shekerdemian, Lara S., Dickerson, Heather A., Fraser, Charles D., Dean McKenzie, E., Heinle, Jeffrey S., Blaine Easley, R.
• Format: Journal Article
• Language: English
• Published: France Blackwell Publishing Ltd 01.03.2014; Wiley Subscription Services, Inc
• Subjects: Anesthetics - administration & dosage; Anesthetics - adverse effects; Brain - pathology; Brain Diseases - chemically induced; Brain Diseases - pathology; Brain Diseases - psychology; Cardiac Surgical Procedures - adverse effects; Cardiopulmonary Bypass; Cohort Studies; congenital heart disease; Developmental Disabilities - chemically induced; Developmental Disabilities - epidemiology; Developmental Disabilities - physiopathology; Female; general anesthesia; Heart Defects, Congenital - psychology; Humans; Hypnotics and Sedatives - administration & dosage; Hypnotics and Sedatives - adverse effects; Infant; Infant, Newborn; inhaled agents; intravenous agents; Language Development Disorders - chemically induced; Language Development Disorders - epidemiology; Magnetic Resonance Imaging; Male; neonate; Nervous System - drug effects; Nervous System - growth & development; neurodevelopment; Neuropsychological Tests; Perioperative Period; Retrospective Studies; congenital heart disease; inhaled agents; intravenous agents; neonate; neurodevelopment; general anesthesia
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1111/pan.12350

Summary Background Adverse neurodevelopmental outcomes are observed in up to 50% of infants after complex cardiac surgery. We sought to determine the association of perioperative anesthetic exposure with neurodevelopmental outcomes at age 12 months in neonates undergoing complex cardiac surgery and to determine the effect of brain injury determined by magnetic resonance imaging (MRI). Methods Retrospective cohort study of neonates undergoing complex cardiac surgery who had preoperative and 7‐day postoperative brain MRI and 12‐month neurodevelopmental testing with Bayley Scales of Infant and Toddler Development, Third Edition (Bayley‐III). Doses of volatile anesthetics (VAA), benzodiazepines, and opioids were determined during the first 12 months of life. Results From a database of 97 infants, 59 met inclusion criteria. Mean ± sd composite standard scores were as follows: cognitive = 102.1 ± 13.3, language = 87.8 ± 12.5, and motor = 89.6 ± 14.1. After forward stepwise multivariable analysis, new postoperative MRI injury (P = 0.039) and higher VAA exposure (P = 0.028) were associated with lower cognitive scores. ICU length of stay (independent of brain injury) was associated with lower performance on all categories of the Bayley‐III (P < 0.02). Conclusions After adjustment for multiple relevant covariates, we demonstrated an association between VAA exposure, brain injury, ICU length of stay, and lower neurodevelopmental outcome scores at 12 months of age. These findings support the need for further studies to identify potential modifiable factors in the perioperative care of neonates with CHD to improve neurodevelopmental outcomes.