Dramatic reductions in surgical mortality for children with congenital heart disease (CHD) have enabled investigators to focus on factors affecting quality of life and neurologic morbidity. Patients with CHD are at significant risk of neurologic impairment from altered perfusion and hypoxemia. Brain ischemia can occur as a result of abnormal blood flow due to CHD, associated congenital anomalies, or issues related to modifiable factors in the intensive care unit. The broad objective of this concept proposal is to demonstrate that near infrared spectroscopy (NIRS) cerebral tissue oxygenation index (TOI) will identify significant cerebral ischemia and provide an opportunity for real-time intervention in the intensive care unit.
Aim 1 will determine whether perioperative NIRS cerebral TOI differs between CHD patients versus normal newborns.
Aim 2 will determine the association between NIRS cerebral TOI in the perioperative period with neurodevelopmental outcome and brain MRI findings. Neonates undergoing cardiac surgery requiring cardiopulmonary bypass will have NIRS monitoring preoperatively, intraoperatively and postoperatively. These neonates will also undergo pre- and postoperative brain MRI and formal neurodevelopmental testing. Neurodevelopmental follow up will occur at 6, 15, and 21 months. Longitudinal multiple linear regression models will be developed to evaluate whether neurodevelopmental changes and brain abnormalities on MRI are related to cerebral TOI in the perioperative period. If established as a predictor, then optimizing TOI will provide the basis for future interventional studies in the ICU to improve neurodevelopmental outcomes.
Mortality in pediatric intensive care units has decreased dramatically, however survivors are at risk for neurologic morbidity. The proposed work seeks to develop better real time monitors of brain injury in the pediatric intensive care unit.
|Pollack, Murray M; Holubkov, Richard; Funai, Tomohiko et al. (2014) Relationship between the functional status scale and the pediatric overall performance category and pediatric cerebral performance category scales. JAMA Pediatr 168:671-6|
|Jardine, David; Emond, Mary; Meert, Kathleen L et al. (2014) A single nucleotide polymorphism in the corticotropin receptor gene is associated with a blunted cortisol response during pediatric critical illness. Pediatr Crit Care Med 15:698-705|
|Meert, Kathleen L; Eggly, Susan; Berg, Robert A et al. (2014) Feasibility and perceived benefits of a framework for physician-parent follow-up meetings after a child's death in the PICU. Crit Care Med 42:148-57|
|Berg, Robert A; Sutton, Robert M; Holubkov, Richard et al. (2013) Ratio of PICU versus ward cardiopulmonary resuscitation events is increasing. Crit Care Med 41:2292-7|
|Moler, Frank W; Silverstein, Faye S; Meert, Kathleen L et al. (2013) Rationale, timeline, study design, and protocol overview of the therapeutic hypothermia after pediatric cardiac arrest trials. Pediatr Crit Care Med 14:e304-15|
|Heidemann, Sabrina M; Holubkov, Richard; Meert, Kathleen L et al. (2013) Baseline serum concentrations of zinc, selenium, and prolactin in critically ill children. Pediatr Crit Care Med 14:e202-6|
|Berger, John T; Carcillo, Joseph A; Shanley, Thomas P et al. (2013) Critical pertussis illness in children: a multicenter prospective cohort study. Pediatr Crit Care Med 14:356-65|
|Anand, Kanwaljeet J S; Clark, Amy E; Willson, Douglas F et al. (2013) Opioid analgesia in mechanically ventilated children: results from the multicenter Measuring Opioid Tolerance Induced by Fentanyl study. Pediatr Crit Care Med 14:27-36|
|Bell, Michael J; Kochanek, Patrick M (2013) Pediatric traumatic brain injury in 2012: the year with new guidelines and common data elements. Crit Care Clin 29:223-38|
|Carcillo, Joseph A; Dean, J Michael; Holubkov, Richard et al. (2012) The randomized comparative pediatric critical illness stress-induced immune suppression (CRISIS) prevention trial. Pediatr Crit Care Med 13:165-73|
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