The following is a summary of “Declining Incidence of Postoperative Neonatal Brain Injury in Congenital Heart Disease,” published in the January 2023 issue of Cardiology by Peyvandi, et al.
Neurodevelopmental outcomes are impacted by brain damage, which is frequent in newborns with complicated neonatal congenital heart disease (CHD). For a study, researchers intended to evaluate whether the frequency of preoperative and postoperative brain damage identified by brain magnetic resonance imaging (MRI) and associated clinical risk factors had altered over time in complicated CHD in light of developments in perioperative treatment.
Between 2001 and 2021, 466 MRI scans were performed on 270 term babies with complicated CHD who were prospectively recruited for preoperative and postoperative brain MRIs. Using logistic regression, 4 epochs at 5-year intervals were used to compare clinical variables with white matter injury (WMI) or localized stroke-related brain lesions.
Preoperative WMI and stroke rates were stable throughout time. However, the chances of newly acquired postoperative WMI were substantially lower in Epoch 4 compared with Epoch 1 (OR: 0.29; 95% CI: 0.09-1.00; P = 0.05) after controlling for the time of the postoperative MRI, location, and cardiac group. From Epoch 1 (24%) to Epoch 4 (6%), the adjusted likelihood of postoperative WMI decreased dramatically by 18.7%. Among clinical risk variables, the lowest systolic, mean, and diastolic blood pressures in the first 24 hours following surgery were considerably higher in the most recent period.
Preoperative WMI rates remained stable. However, postoperative WMI prevalence had decreased. Stronger postoperative blood pressures may help to explain the results by reducing ischemia times and promoting brain perfusion. The findings pointed to possible therapeutic targets that might be altered postoperatively to lessen the burden of WMI.
Reference: jacc.org/doi/10.1016/j.jacc.2022.10.029