The association between brain injury, perioperative anesthetic exposure, and 12‐month neurodevelopmental outcomes after neonatal cardiac surgery: a retrospective cohort study

Abstract

Summary Background Adverse neurodevelopmental outcomes are observed in up to 50% of infants after complex cardiac surgery. We sought to determine the association of perioperative anesthetic exposure with neurodevelopmental outcomes at age 12 months in neonates undergoing complex cardiac surgery and to determine the effect of brain injury determined by magnetic resonance imaging (MRI). Methods Retrospective cohort study of neonates undergoing complex cardiac surgery who had preoperative and 7-day postoperative brain MRI and 12-month neurodevelopmental testing with Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). Doses of volatile anesthetics (VAA), benzodiazepines, and opioids were determined during the first 12 months of life. Results From a database of 97 infants, 59 met inclusion criteria. Mean ± sd composite standard scores were as follows: cognitive = 102.1 ± 13.3, language = 87.8 ± 12.5, and motor = 89.6 ± 14.1. After forward stepwise multivariable analysis, new postoperative MRI injury (P = 0.039) and higher VAA exposure (P = 0.028) were associated with lower cognitive scores. ICU length of stay (independent of brain injury) was associated with lower performance on all categories of the Bayley-III (P < 0.02). Conclusions After adjustment for multiple relevant covariates, we demonstrated an association between VAA exposure, brain injury, ICU length of stay, and lower neurodevelopmental outcome scores at 12 months of age. These findings support the need for further studies to identify potential modifiable factors in the perioperative care of neonates with CHD to improve neurodevelopmental outcomes.

MRI for neurodevelopmental prognostication in the high-risk term infant

“…In a larger retrospective analysis (n ¼ 59), these investigators evaluated the relationship between volatile anesthetic exposure and neurodevelopmental outcomes in a mixed cohort of CHD patients and found that new postoperative MRI injury was also an independent predictor of Bayley-III cognitive (p ¼ 0.04), language (p ¼ 0.02), and motor performance (p ¼ 0.05) at 12 months. 99 In contrast, Beca et al 100 reported no association between pre-or postoperative MRI injury with neurodevelopmental outcome at 2 years in a cohort of infants with mixed CHD lesions (n ¼ 153), although delayed myelination of the PLIC was associated with lower motor scores (p ¼ 0.049). Due to this uncertainty, most centers do not routinely perform pre-and/or post-operative MRIs in asymptomatic CHD infants.…”

Isoflurane but not Fentanyl Causes Apoptosis in Immature Primary Neuronal Cells

“…However, in term infants undergoing complex cardiac surgery, a positive association between volatile anaesthetic exposure (isoflurane), MRI-assessed brain injury, and lower neurodevelopmental outcome scores at 12 months of age were demonstrated [39]. In term infants undergoing major non-cardiac surgery, cognitive and motor developmental delay at 2 years of age was found in less than a quarter of the children assessed, with neurodevelopmental outcome scores on average 0.5 SD below the normative score of the healthy population [6].…”

Cognition and Brain Structure Following Early Childhood Surgery With Anesthesia

“…However, to our knowledge, these observations represent the first structural assessment of the human brain after surgery with anesthesia early in life in otherwise healthy children, whereas a recent study in survivors of complex congenital heart surgery has linked brain injury observed on MRI with cognitive and language scores in critically ill infants. 38 Our study has several limitations. The MRI data used in this study are…”