Neurodevelopmental Outcome after Cardiac Intensive Care

描述（由申请人提供）：先天性心脏病（CHD）患儿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。冠心病患者因灌注改变和低氧血症而具有显著的神经功能损害风险。由于冠心病、相关先天性异常或重症监护病房中可改变因素相关的问题导致的血流量异常可导致脑缺血。该概念提案的总体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将确定围手术期NIRS脑TOI在冠心病患者和正常新生儿之间是否存在差异。目的2将确定围手术期NIRS脑TOI与神经发育结局和脑MRI表现之间的关系。接受心脏手术需要体外循环的新生儿将在术前、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。神经发育随访将在6、15和21个月进行。我们将建立纵向多元线性回归模型来评估围手术期神经发育变化和MRI上的脑部异常是否与脑TOI有关。如果将TOI作为一种预测指标，那么优化TOI将为未来ICU的介入研究提供基础，以改善神经发育结局。

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.