Effects Of RSO₂ On Neurodevelopmental Outcome One Year After Surgery In Neonates And Infants With Congenital Heart Diseases

Purpose To explore the effect of Preoperative and postoperative regional cerebral oxygen saturation（RSO₂）and other factors on neurodevelopmental outcomes 1 year after cardiac surgery in newborns and infants.Method A total of 30 children（including 20 males and 10 females）who were hospitalized in our hospital for congenital heart surgery from October 2019 to May2020 were selected.All of them met the enrollment Criteria and completed data collection.Among them,3 cases（10%）were premature babies.The average age of surgery was 21.93±29.77d（1d～109d）;the average body weight before surgery was3.34±0.93kg（1.69～6.30Kg）.Applied near-infrared spectroscopy（NIRS）to monitor and record RSO₂before and 48 hours after surgery,and collected perioperative data.At 1 year after surgery,physical development was assessed and Bailey Infant Development Inventory（BSID）was used for neurodevelopmental assessment（MDI,PDI）.Analyze the effects of RSO₂and other risk factors on neurodevelopmental outcomes before and within 48 hours after surgery.SPSS 19.0 was selected for statistical analysis.Result 1.The results of BSDI evaluation showed that the Mental Development Index（MDI）was 83.93±12.63,and the psychomotor Development Index（PDI）was86.67±13.77,which was slightly higher than MDI.30%of the children in this study were in critical state or retarded state in MDI while 23.3%in PDI.The independent sample t test was used to compare the mental development index（MDI）and psychomotor development index（PDI）with healthy children（mean value was 100）,and the results indicated P<0.001,the difference was statistically significant.2.RSO2 changed significantly with time.More than half of the children had abnormal cerebral oxygenation before surgery,and cerebral oxygen saturation showed a gradual upward trend after surgery.The children with abnormal cerebral oxygenation 6 hours after surgery accounted for the highest proportion,about 80%.Cerebral oxygenation began to improve at 12 hours postoperatively,and most of the children returned to normal range at 48 hours postoperatively.The mean value of RSO₂in children with abnormal PDI was significantly lower than that in the normal group at each time point.But there was no significant difference in RSO₂in children with normal and abnormal MDI.3.Stepwise regression analysis indicated that at the time of 12 hours after surgery,the regional cerebral oxygen saturation and the use of deep hypothermic circulatory arrest were related to PDI.And the regional cerebral oxygen saturation 24 hours after surgery was related to PDI as well.But no relationship was found between regional cerebral oxygen saturation and MDI.The lactic acid at the time admitted to CICU（R=0.224,P=0.008）,12h after surgery（R=0.240,P=0.006）and 24h after surgery（R=0.234,P=0.007）were related to MDI.Conclusion 1.Neonates and infants have delayed neurodevelopmental outcomes compared with those of healthy children after cardiac surgery.2.RSO₂has different effects on different neurodevelopmental functions in children.It is an influential factor in psychomotor development（PDI）one year after surgery.The RSO₂of children with abnormal PDI decreased significantly before and after surgery,and significantly related to PDI.However,it was not associated with intellectual development（MDI）.3.Deep hypothermic circulatory arrest was a negative factor for PDI at 1 year postoperatively.4.The change of postoperative serum lactic acid has negative influence on mental development outcome（MDI）one year after surgery,and there is a linear correlation between them.