73 - Cerebral and Splanchnic Tissue Oxygenation are Chronically Affected in Premature Infants with Ductal- Dependent Congenital Heart Disease.

Poster Number: 73
Publication Number: 73.437

Anastasiya Mankouski, University of Utah, Salt lake, UT, United States; Timothy M. Bahr, Intermountain Healthcare, Salt Lake City, UT, United States; Katherine Braski, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, United States; Kimberlee A. Weaver Lewis, Intermountain Healthcare, Murray, UT, United States; Mariana Baserga, University of Utah, Park City, UT, United States

Background: Premature infants with prostaglandin (PGE)-dependent congenital heart disease (CHD) are at significant risk for feeding intolerance and/or necrotizing enterocolitis (NEC), as well as at risk for poor neurodevelopmental outcomes. Using Near Infrared Spectroscopy (NIRS) we hypothesized that these infants will demonstrate chronic preoperative decreased regional cerebral and splanchnic oxygenation (rSO2) when compared to matched control infants.

Objective: To determine whether premature infants with PGE-dependent CHD have impaired cerebral and intestinal oxygenation compared to control infants.

Design/Methods: Cerebral and splanchnic rSO2 were monitored using NIRS for 48 hours in premature infants < 36 weeks gestational age (GA) with PGE-dependent CHD and control infants (no CHD or PDA). Both groups were receiving bolus enteral feedings and were >14 days of life. We used a mixed effects model to estimate the effect of CHD and feedings on splanchnic and cerebral NIRS; and to account for multiple measurements on the same subject at three different times around multiple feedings (30 min baseline, duration of each feeding, and 30 min post feeding time).

Results: Twenty-four subjects were enrolled in the study (10 with CHD and 14 controls). One control subject was excluded from the data set due to a malfunctioning NIRS device that resulted in aberrant readings. The final data set included 897 measurements on 23 subjects. The CHD group had a median GA of 34 (28-36) weeks with a mean birthweight of 1811g.  The Control group had a median GA of 33 (28-34) weeks and mean birth weight of 1820g. On average, cerebral NIRS measurements were 9.5 points higher in controls than cases (p-value=0.003)(Fig1); and splanchnic NIRS measurements were 13.1 points higher in controls than cases (p-value=0.001) (Fig2).Conclusion(s): These results demonstrate an overall significantly lower cerebral and splanchnic rSO2 in premature infants with PGE-dependent CHD compared to control infants. This data raises concerns regarding how unrepaired cyanotic CHD can chronically limit systemic oxygenated blood flow directly contributing to cerebral and gastrointestinal hypoperfusion and ischemia, ultimately increasing the risk for poor neurodevelopmental outcomes and NEC in premature infants.
Cerebral and splanchnic NIRS measurements.