Timing of Cardiopulmonary Bypass and Risk of Neurological Injury in Premature Infants with Congenital Heart Disease

Background: To investigate the impact of timing of cardiopulmonary bypass surgery (CPB) on neurological injuries in premature infants with congenital heart disease (CHD) who underwent cardiac surgery in the first 2 months of age.

Methods: We performed a 16-year (2008–2023) single-center retrospective cohort study of premature infants (delivered at <37 weeks gestational age, GA) at Boston Children’s Hospital who underwent CPB for selected cardiac operations at less than 2 months of age. The primary outcome was neurological injury following CPB, defined as new or evolving intraventricular/parenchymal hemorrhage (diagnosed by head ultrasound), periventricular leukomalacia (confirmed by magnetic resonance imaging of the brain), or seizures (confirmed by electroencephalography). As a secondary outcome, we investigated the relationship between timing of CPB and in-hospital mortality. Logistic regression was employed to investigate the influence of timing of CPB surgery on the likelihood of the outcomes, adjusting for potential confounders such as GA at birth, birth weight, weight at CPB surgery, STAT category, and cross-clamp time.

Results: We identified 191 preterm infants (median GA of 34 weeks at delivery and birth weight of 2,300 g) with CHD who underwent CPB less than 2 months of age, of which 50 (26%) infants met the primary outcome of neurological injury (Table 1). On multivariate analysis, age at CPB surgery was not associated with neurological injury (OR 0.97: 0.94–1.00, p = 0.10) or in-hospital mortality (OR 1.01: 0.98–1.05, p = 0.37).

Conclusion: Premature infants are at higher risk for the development of adverse neurological outcomes in general, but this 16-year study of premature infants with CHD who underwent surgery with CPB at less than 2 months of age found that the timing of CPB does not confer additional risk for acute neurological injury, or impact mortality. Future research should focus on determining ideal timing for surgical intervention in this patient population, which will inform decision-making and provide clinicians with a roadmap for managing the cardiac intervention in these high-risk neonates.

Publikationsverlauf

Artikel online veröffentlicht:
11. Februar 2025