Predictive Value of Near-infrared Spectroscopy on Neurodevelopmental Outcome After Surgery for Congenital Heart Disease in Infancy

Objective: To explore the relationship between intraoperative regional cerebral oxygen saturation (rSO(2)) measured by near-infrared spectroscopy (NIRS) and neurodevelopmental outcome in children after cardiac surgery.

Methods: Cross-sectional neurodevelopmental evaluation at 2 years of age was performed in a cohort of young infants who had surgery for congenital heart disease in 2007. The third edition of Bayley Scales of Infant and Toddler Development (Bayley-III) was used to assess cognitive, language, and motor functioning. Clinical and perioperative data were collected, including intraoperative rSO(2) nadir, rSO(2) percent decrease from baseline, and cumulative minutes of at least 20%, 30%, and 40% decrease from baseline.

Results: Twenty-seven patients without chromosomal abnormality were included in analyses. Mean Bayley-III scores fell within 1 standard deviation of the normative mean. Stepwise regression analyses of patient- and procedure-related variables, including rSO(2), demonstrated that cognitive ability was predicted by length of hospital stay and premature birth (58.1% of variance), receptive communication was predicted by length of hospital stay and rSO(2) nadir (40.2% of variance), expressive communication was predicted by birth weight (26.2% of variance), fine motor functioning was predicted by duration of cardiac intensive care unit stay (41.4% of variance), and gross motor functioning was predicted by the presence of a significant comorbidity (43.5% of variance).

Conclusions: In a contemporary cohort of infants undergoing surgery for congenital heart disease, neurodevelopmental outcomes at 2 years of age are largely influenced by patient-related characteristics. Although receptive communication appears to be influenced by rSO(2) nadir, the predictive value of NIRS remains unclear.