Neurodevelopmental Outcome after Cardiac Intensive Care

描述（由申请人提供）：先天性心脏病（CHD）儿童手术死亡率的显著降低使研究人员能够关注影响生活质量和神经系统发病率的因素。冠心病患者存在灌注改变和低氧血症导致神经功能损害的显著风险。脑缺血可能是由于CHD导致的异常血流、相关的先天性异常或与重症监护室中的可变因素相关的问题而发生的。该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）将识别显著的脑缺血，并为重症监护室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将确定围手术期NIRS脑TOI与神经发育结局和脑MRI结果之间的关系。接受需要体外循环的心脏手术的新生儿将在术前、术中和术后进行NIRS监测。这些新生儿还将接受术前和术后脑MRI和正式的神经发育测试。将在6、15和21个月时进行神经发育随访。将开发纵向多元线性回归模型，以评估神经发育变化和MRI上的脑异常是否与围手术期的脑TOI相关。如果作为一个预测因素，那么优化TOI将为未来在ICU进行干预性研究以改善神经发育结局提供基础。 公共卫生相关性：儿科重症监护病房的死亡率显著下降，但幸存者仍有神经系统疾病的风险。拟议的工作旨在开发更好的真实的时间监测脑损伤的儿科重症监护病房。

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.