Experimental Brain Research

, Volume 165, Issue 3, pp 343–350 | Cite as

Cerebral oxygen saturation and electrical brain activity before, during, and up to 36 hours after arterial switch procedure in neonates without pre-existing brain damage: its relationship to neurodevelopmental outcome

  • Mona C. Toet
  • Annebeth Flinterman
  • Ingrid van de Laar
  • Jaap W. de. Vries
  • Ger B. W. E. Bennink
  • Cuno S. P. M. Uiterwaal
  • Frank van Bel
Research Article

Abstract

Objective: To monitor the pattern of cerebral oxygen saturation (rSat), by use of NIRS, in term infants before, during and after the arterial switch operation and to evaluate its relation to neurodevelopmental outcome. Methods: In 20 neonates without pre-existing brain damage hemodynamics and arterial oxygen saturation (AO2-Sat) were monitored simultaneously with rSat and amplitude-integrated EEG (aEEG) from 4 h to 12 h before up to 36 h after cardiopulmonary bypass (CPB) and short duration of cardiac arrest during deep hypothermia (DHCA). The Bayleys developmental scale was performed at 30 months. Results: Before surgery rSat was <50% in 16 patients. During CPB rSat increased to normal values, with a sharp decrease during brief CA (median 6.5 min). Post-CPB rSat showed a transient decrease (30–45%) despite normal PaO2 with sustained normalization after 6–26 h. Recovery time of the rSat seemed longer when pre-operative rSat was below 35%, and for lower minimum nasopharyngeal temperature and longer duration of CPB and of DHCA. Recovery time of the aEEG varied and did not correlate with normalization of rSat. Neurodevelopmental outcome was normal in all but two patients. Patients with lower pre-operative rSat (<35%) tended to have lower DQ (developmental quotient) scores at 30–36 months. (median: mental 102 and motor 101 (range 58–125) compared with mental 100 and motor 110 (range 83–125)) Conclusion: Despite prompt normalization of circulation and oxygenation after surgery, recovery of rSat of the brain took 6–26 h, probably because of higher energy demand after CPB. Pre-operative cerebral oxygenation may be underestimated as a possible cause of adverse post-operative outcome.

Keywords

Newborn Arterial switch operation Cerebral oxygenation Electrical brain activity Neurodevelopmental outcome 

Abbreviations

aEEG

Amplitude integrated electroencephalogram

CPB

Cardiopulmonary bypass

CA

Cardiac arrest

DHCA

Circulatory arrest during deep hypothermia

NIRS

Near infrared spectroscopy

rSAT

Regional cerebral oxygen saturation

TGA

Transposition of the great arteries

CVP

Central venous pressure

PaO2

Arterial oxygen pressure

AO2-sat

Arterial oxygen saturation

CBV

Cerebral blood volume

DQ

Developmental Quotient

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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Mona C. Toet
    • 1
  • Annebeth Flinterman
    • 1
  • Ingrid van de Laar
    • 1
  • Jaap W. de. Vries
    • 2
  • Ger B. W. E. Bennink
    • 3
  • Cuno S. P. M. Uiterwaal
    • 4
  • Frank van Bel
    • 1
  1. 1.Department of Neonatology, KE 04.123.1University Medical Center Utrecht/ Wilhelmina Children’s HospitalUtrechtThe Netherlands
  2. 2.Departments of AnesthesiologyUniversity Medical Center Utrecht/ Wilhelmina Children’s HospitalUtrechtThe Netherlands
  3. 3.Department of CardioThoracic SurgeryUniversity Medical Center Utrecht/ Wilhelmina Children’s HospitalUtrechtThe Netherlands
  4. 4.Julius Center for Patient Oriented ResearchUniversity Medical Center Utrecht/ Wilhelmina Children’s HospitalUtrechtThe Netherlands

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