Elevated cranial ultrasound resistive indices are associated with improved neurodevelopmental outcomes one year after pediatric cardiac surgery: A single center pilot study

Heart Lung. 2017 Jul-Aug;46(4):251-257. doi: 10.1016/j.hrtlng.2017.04.009. Epub 2017 May 13.

Abstract

Objective: To determine if a non-invasive, repeatable test can be used to predict neurodevelopmental outcomes in patients with congenital heart disease.

Methods: This was a prospective study of pediatric patients less than two months of age undergoing congenital heart surgery at the Children's Health Children's Medical Center at Dallas. Multichannel near-infrared spectroscopy (NIRS) was utilized during the surgery, and ultrasound (US) resistive indices (RI) of the major cranial vessels were obtained prior to surgery, immediately post-operatively, and prior to discharge. Pearson's correlation, Fischer exact t test, and Fischer r to z transformation were used where appropriate.

Results: A total of 16 patients were enrolled. All had US data. Of the sixteen patients, two died prior to the neurodevelopmental testing, six did not return for the neurodevelopmental testing, and eight patients completed the neurodevelopmental testing. There were no significant correlations between the prior to surgery and prior to discharge US RI and neurodevelopmental outcomes. The immediate post-operative US RI demonstrated a strong positive correlation with standardized neurodevelopmental outcome measures. We were able to demonstrate qualitative differences using multichannel NIRS during surgery, but experienced significant technical difficulties implementing consistent monitoring.

Conclusions: A higher resistive index in the major cerebral blood vessels following cardiac surgery in the neonatal period is associated with improved neurological outcomes one year after surgery. Obtaining an ultrasound with resistive indices of the major cerebral vessels prior to and after surgery may yield information that is predictive of neurodevelopmental outcomes.

Keywords: Near-infrared spectroscopy; Neurodevelopmental outcomes; Pediatric cardiac intensive care; Pediatric congenital heart surgery; Ultrasound resistive indices.

MeSH terms

  • Brain / diagnostic imaging*
  • Cardiac Surgical Procedures / adverse effects*
  • Female
  • Follow-Up Studies
  • Heart Defects, Congenital / surgery*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Neurodevelopmental Disorders / diagnosis*
  • Neurodevelopmental Disorders / etiology
  • Pilot Projects
  • Postoperative Period
  • Prospective Studies
  • Time Factors
  • Ultrasonography, Doppler, Transcranial / methods*