165 - Decreased pre-operative cerebral oxygenation and abnormal neonatal neurobehavior in complex congenital heart disease

Poster Number: 165
Publication Number: 165.101

Geena Y. Zhou, Children's Hospital Los Angeles, Los Angeles, CA, United States; Carlin A. Merkel, Keck School of Medicine of the University of Southern California, Plymouth, MN, United States; Vidya Rajagopalan, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States; Ashok Panigrahy, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Jodie K. Votava-Smith, Children's Hopsital Los Angeles, Los Angeles, CA, United States; Nhu Tran, Children's Hospital Los Angeles/USC, Los Angeles, CA, United States

Background: Children with congenital heart disease (CHD) are at higher risk for poor neurodevelopmental outcomes when compared to their healthy counterparts. One proposed mechanism is decreased cerebral oxygenation related to their CHD, which impairs brain development, but the relationship between pre-operative neonatal brain oxygenation and neonatal neurobehavior is unknown.

Objective: This study aims to determine the association between cerebral oxygenation saturation (rsO2) and a concurrent neonatal neurobehavioral assessment, to assess factors that may influence neurodevelopment in neonates with CHD compared to healthy controls. We hypothesized that lower pre-operative rsO2 would significantly associate with poorer neonatal neurobehavioral assessment scores in CHD neonates compared to controls.

Design/Methods: We measured pre-operative rsO2 using Near-Infrared Spectroscopy in a sample of term neonates with complex CHD and controls. Primary outcome: Percent abnormality on the Einstein Neonatal Neurobehavioral Assessment Scale (ENNAS). Exclusion: prematurity, invasive ventilation at time of assessment, and genetic syndromes. Spearman’s rank correlation assessed the relationship between variables. A linear regression model examined the association between percent abnormality on ENNAS and rsO2, while adjusting for group (CHD vs. control) and post-conceptional age at testing.

Results: We assessed 32 CHD neonates and 38 healthy controls. The majority of infants were Hispanic and other sociodemographics did not differ significantly between groups (Table 1). Both groups had similar gestational age, though CHD neonates averaged 1 week younger than controls at time of testing (39.1 vs. 40.4, p< 0.001), consisted of 65% cyanotic CHD, had lower rsO2, and had poorer ENNAS scores compared to controls (p < 0.001). Lower rsO2 values correlated with poorer ENNAS scores (r=-0.33, p=0.005). Our model found that rsO2 explained 35% of the variance in ENNAS scores when adjusting for post-conceptional age at testing and group, though it was not statistically significant (R2=0.35, p=0.160). CHD infants scored 4% poorer on ENNAS compared to controls when controlling for rsO2 and post-conceptional age (β=4.32, p< 0.001).Conclusion(s): Lower pre-operative cerebral oxygenation associated with abnormal concurrent neurobehavioral assessment in our sample overall. Thus, identifying the highest-risk CHD neonates can help providers target developmental therapies to improve outcomes. We are continuing to examine the longitudinal associations between rsO2, socio-demographic factors, and infant neurodevelopmental outcomes in this cohort.
Geena_Zhou_CVGeena_Zhou_CV_12-20-2021.pdf
Figure 1. Scatterplot of Average rsO2 vs. ENNAS % Abnormal Score separated by group.