Differences in cerebral oxygen saturation and extraction between infants with prenatally and infants with postnatally diagnosed duct-dependent congenital heart disease during the first 72 hours after admission.

Schat, M.A. (2015) Differences in cerebral oxygen saturation and extraction between infants with prenatally and infants with postnatally diagnosed duct-dependent congenital heart disease during the first 72 hours after admission. thesis, Medicine.

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Abstract

Background: Congenital heart disease (CHD) is one of the most common developmental defects, occurring in approximately 6 to 13 per 1000 live births. Prenatal diagnosis of CHD by way of fetal echocardiography is increasingly common and might contribute to a better preoperative condition and postoperative outcome and therefore better oxygenation of the brain, than infants of whom the diagnosis CHD is made after birth. Aim: To explore whether there is a difference in the course of regional cerebral tissue oxygen saturation (rcSO2) and cerebral fractional tissue oxygen extraction (FTOE) during the first 72 hours after admission at the Neonatal Intensive Care Unit (NICU) between neonates with prenatally diagnosed duct-dependent CHD and neonates with postnatally diagnosed duct-dependent CHD. Methods: We conducted a retrospective study in patients with a duct-dependent CHD and divided the patients into two groups: prenatally or postnatally diagnosed CHD. Neonates with prenatally diagnosed duct-dependent CHD who were admitted to the NICU of the University Medical Center Groningen (UCMG) between December 2007 and November 2012 were selected from a database at the UMCG if cerebral oxygen saturation (rcSO2) was routinely measured by NIRS. Infants with postnatally diagnosed CHD who were admitted to the NICU of the UMCG, and had also routinely measured rcSO2, were selected between January 2008 and July 2012. Inclusion criteria included a duct-dependent CHD, treatment with Prostaglandin E1, and a gestational age of at least 35 weeks. Infants with major chromosomal disorders were excluded from the study. Furthermore, infants were also excluded when NIRS-data was missing for more than 48 hours. Eventually, we included 29 infants with prenatally diagnosed CHD and 20 infants with postnatally diagnosed CHD. Clinical and biochemical parameters were collected from a large database and from medical records, respectively. To identify the course of rcSO2 and FTOE in the first 72 hours after admission at the NICU, mean rcSO2 and FTOE were calculated during a stable one hour period for every 6 hours, creating 12 time periods per infant. Results: Infants with prenatally diagnosed CHD had a median gestational age of 39.3 weeks (range 36.6-41.9 weeks), a median birth weight of 3370 grams (range 1960-4065 grams) and a median SNAP II of 9 (range 0-42). Infants with postnatally diagnosed CHD had a median gestational age of 39.4 weeks (range 35.7-42.0 weeks), median birth weight of 3573 (range 2190-4270 grams) and median SNAP II of 14.5 (range 5-55). No differences were found in rcSO2 values between the group with prenatally and the group with postnatally diagnosed duct-dependent CHD (median 58.3% vs 58.5%, P = 0.67 within 24 hours; median 62.1% vs 59.5%, P = 0.37 between 24 and 48 hours; median 60.8% vs 60%, P = 0.76 between 48 and 72 hours). Furthermore, no differences were found in the course of FTOE between the group with prenatally and the group with postnatally diagnosed duct-dependent CHD (median 0.35 vs 0.34, P = 0.90 within 24 hours; median 0.33 vs 0.33, P = 0.93 between 24 and 48 hours; median 0.34 vs 0.33, P = 0.70 between 48 and 72 hours). Conclusion: We demonstrated that there were no differences in the course of rcSO2 and FTOE during the first 72 hours after admission at the NICU between neonates with prenatally diagnosed duct-dependent CHD and neonates with postnatally diagnosed duct-dependent CHD. We did find, however, low rcSO2 and high FTOE values on each day in both groups.

Item Type:	Thesis (Thesis)
Supervisor name:	Kooi, E.M.W.
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:04
Last Modified:	25 Jun 2020 11:04
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2418

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