Neurodevelopmental Outcome after Cardiac Intensive Care

描述(由申请人提供)：先天性心脏病(CHD)儿童手术死亡率的大幅下降使研究人员能够专注于影响生活质量和神经发病率的因素。冠心病患者有因血流灌注改变和低氧血症而导致神经损伤的显著风险。脑缺血的发生可能是由于CHD引起的血流异常、相关的先天性异常或与重症监护病房中的可改变因素有关的问题。这一概念提案的广泛目标是证明近红外光谱(NIRS)脑组织氧合指数(TOI)将识别严重的脑缺血，并为重症监护病房的实时干预提供机会。目的1将确定CHD患者与正常新生儿围手术期NIRS脑TOI是否不同。目的2确定围手术期近红外反射脑TOI与神经发育结局和脑MRI表现的关系。需要体外循环进行心脏手术的新生儿将在术前、术中和术后进行近红外光谱监测。这些新生儿还将接受术前和术后的脑MRI和正式的神经发育测试。神经发育随访将在6个月、15个月和21个月进行。建立纵向多元线性回归模型，以评估围手术期神经发育改变和脑MRI异常是否与脑TOI有关。如果被确定为预测指标，那么优化TOI将为未来在ICU进行干预研究以改善神经发育结果提供基础。 公共卫生相关性：儿科重症监护病房的死亡率已大幅下降，但幸存者有患神经疾病的风险。这项拟议的工作旨在开发更好的儿科重症监护病房脑损伤实时监测仪。

DESCRIPTION (provided by applicant): Dramatic reductions in surgical mortality for children with congenital heart disease (CHD) have enabled investigators to focus on factors affecting quality of life and neurologic morbidity. Patients with CHD are at significant risk of neurologic impairment from altered perfusion and hypoxemia. Brain ischemia can occur as a result of abnormal blood flow due to CHD, associated congenital anomalies, or issues related to modifiable factors in the intensive care unit. The broad objective of this concept proposal is to demonstrate that near infrared spectroscopy (NIRS) cerebral tissue oxygenation index (TOI) will identify significant cerebral ischemia and provide an opportunity for real-time intervention in the intensive care unit. Aim 1 will determine whether perioperative NIRS cerebral TOI differs between CHD patients versus normal newborns. Aim 2 will determine the association between NIRS cerebral TOI in the perioperative period with neurodevelopmental outcome and brain MRI findings. Neonates undergoing cardiac surgery requiring cardiopulmonary bypass will have NIRS monitoring preoperatively, intraoperatively and postoperatively. These neonates will also undergo pre- and postoperative brain MRI and formal neurodevelopmental testing. Neurodevelopmental follow up will occur at 6, 15, and 21 months. Longitudinal multiple linear regression models will be developed to evaluate whether neurodevelopmental changes and brain abnormalities on MRI are related to cerebral TOI in the perioperative period. If established as a predictor, then optimizing TOI will provide the basis for future interventional studies in the ICU to improve neurodevelopmental outcomes. PUBLIC HEALTH RELEVANCE: Mortality in pediatric intensive care units has decreased dramatically, however survivors are at risk for neurologic morbidity. The proposed work seeks to develop better real time monitors of brain injury in the pediatric intensive care unit.