@Article{chd.12426,
AUTHOR = {Safwat A. Aly, David Zurakowski, Penny Glass, Kami Skurow-Todd, Richard A. Jonas, Mary T. Donofrio},
TITLE = {Cerebral tissue oxygenation index and lactate at 24 hours postoperative predict survival and neurodevelopmental outcome after neonatal cardiac surgery},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {12},
YEAR = {2017},
NUMBER = {2},
PAGES = {188--195},
URL = {http://www.techscience.com/schd/v12n2/39097},
ISSN = {3071-1738},
ABSTRACT = {<b>Importance:</b> There are no well-established noninvasive biomarkers for identifying patients at risk
for poor outcome after surgery for congenital heart disease. Few studies have assessed prognostic
accuracy of cerebral tissue oxygenation index (cTOI) measured by near infrared spectroscopy
(NIRS).<br/>
<b>Objective:</b> To assess the utility of noninvasive NIRS monitoring as a predictor of outcomes after
neonatal cardiac surgery through measurement of cTOI. To examine the utility of noninvasive
NIRS monitoring in combination with lactate concentration and inotropic score in prediction of
outcomes after neonatal cardiac surgery.<br/>
<b>Design:</b> Prospective longitudinal cohort study.<br/>
<b>Setting:</b> Operating room and cardiac intensive care unit, Children’s National Heart Institute.<br/>
<b>Participants:</b> Seventy-five patients with complex congenital heart disease undergoing surgical
repair within first month of life.<br/>
<b>Exposure:</b> Cerebral TOI, blood lactate, and inotropic scores were measured preoperative, intraoperative and up to 24 hours postoperative.<br/>
<b>Main Outcome Measures:</b> Postoperative mortality and neurodevelopmental outcome assessed
by the Bayley Scales of Infant Development (BSID II). Mental and motor scores were obtained at
6, 15, and 21 months. Good outcome was defined as survival and BSID mental and motor scores
≥70 points. Poor outcome was defined as death or BSID scores <70 at most recent follow-up.<br/>
<b>Results:</b> Cohort of 75 patients prospectively followed including 40 patients with single ventricle and 35 with two ventricles. Four patients died before discharge and ten died within 21
months. Seven patients were lost to follow-up. Among survivors with follow-up (n = 54), BSID
was abnormal in 25 (46%). Patients with poor outcome (n = 39) had lower mean cTOI 60
minutes off-CPB (48% vs. 58%, P = .003) and 24 hours postoperative (49% vs. 59%, P < .001),
higher lactate (8.2 vs. 5.0 mmol/L, P = .005) and higher inotropic scores (10 vs. 6, P = .02) at
24 hours postoperative. ROC analysis indicated that cTOI had moderate predictive accuracy of
outcome (AUC = 0.751, P < .001). Multivariable regression analysis confirmed that predictive
accuracy was improved using both cTOI and lactate at 24 hours postoperative (AUC = 0.813,
95% CI: 0.705–0.921, P < .001) with optimal cutoff values <58% and >7.4 mmol/L, respectively (sensitivity = 95%).<br/>
<b>Conclusion:</b> Cerebral TOI combined with lactate at 24 hours postoperative are accurate noninvasive predictive biomarkers of patient survival and neurodevelopmental outcome in neonates
with CHD undergoing cardiac surgery.},
DOI = {10.1111/chd.12426}
}