Evaluating neurological integrity in the perianesthesia environment in children with heart disease
Summary
Congenital heart disease affects 1% of children in the United States. New surgical techniques have increased survival rates to 95%. With this positive improvement in mortality, there has been a shift in focus to morbidity, specifically neurodevelopmental disabilities, which affect 75% of children with congenital heart disease. In particular, children with single ventricle physiology are at some of the highest risk for decreased brain volumes and neurodevelopmental disabilities, such as attention deficit hyperactivity disorder, anxiety, and depression. Some infants and children proceed to palliative surgery, while others require early heart transplant. Specific prenatal and postnatal medical, surgical, and social risk factors for poor developmental outcomes have been proposed; however, the complex interplay between these factors and their effects on developmental outcomes is unknown.
Until modifiable risk factors associated with development of neurodevelopmental disabilities are established, neurodevelopmental outcomes for these children will not be improved. Although there is an association between sedation and poor neurodevelopmental outcomes, it is unclear as to whether infants who require more sedation have underlying neurologic factors that lead them to require higher levels of sedation and prolonged intubation, or whether the sedation itself causes downstream developmental effects. We propose a study to assess the integrity of the immature nervous system in infants with the most complex types of congenital heart disease prior to surgical intervention, in the perianesthesia environment, and during recovery. Using tools such as the NICU Network Neurobehavioral Scale, Hammersmith Neonatal Neurologic Examination, General Movement Assessment, and the Capute Scales, we will assess the neurobehavioral and neurodevelopmental status of infants with single ventricle physiology, a complex form of congenital heart disease. We hypothesize that there are existing neurological and neurobehavioral factors that predispose infants to require higher doses of sedation in the perianesthesia environment. We propose the following specific aims:
Aim 1: In infants born with single ventricle physiology, we will evaluate their neurodevelopmental status prior to surgical intervention, in the perianesthesia environment, and the recovery period. Using a prospective study design on patients in the CVICU, we will determine associations between pre-surgical neurologic status, sedation requirements, and post-surgical neurologic and neurodevelopmental outcomes.
Aim 2: In infants born with single ventricle physiology, we will compare traditional sedation weaning protocols, e.g., WAT scores, with other measures of neurologic status. This study will serve as a precursor to the development of a novel algorithm to wean sedation in neurologically and neurobehaviorally complex infants.
Impact. Our multidisciplinary research team expects to identify the relationships between baseline neurologic and neurobehavioral status with subsequent procedural and operative sedation needs. Characterizing these relationships and developing a novel sedation weaning protocol will ultimately guide management strategies to improve outcomes in children with single ventricle physiology.
Keywords:
- neurology
- medical
- Translational Research