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.
|Cornell, Timothy T; Selewski, David T; Alten, Jeffrey A et al. (2018) Acute kidney injury after out of hospital pediatric cardiac arrest. Resuscitation 131:63-68|
|Cashen, Katherine; Reeder, Ron; Dalton, Heidi J et al. (2018) Hyperoxia and Hypocapnia During Pediatric Extracorporeal Membrane Oxygenation: Associations With Complications, Mortality, and Functional Status Among Survivors. Pediatr Crit Care Med 19:245-253|
|Pollack, Murray M; Holubkov, Richard; Reeder, Ron et al. (2018) PICU Length of Stay: Factors Associated With Bed Utilization and Development of a Benchmarking Model. Pediatr Crit Care Med 19:196-203|
|Pollack, Murray M; Holubkov, Richard; Berg, Robert A et al. (2018) Predicting cardiac arrests in pediatric intensive care units. Resuscitation 133:25-32|
|Cashen, Katherine; Reeder, Ron; Dalton, Heidi J et al. (2018) Acquired infection during neonatal and pediatric extracorporeal membrane oxygenation. Perfusion 33:472-482|
|Berg, Robert A; Sutton, Robert M; Reeder, Ron W et al. (2018) Association Between Diastolic Blood Pressure During Pediatric In-Hospital Cardiopulmonary Resuscitation and Survival. Circulation 137:1784-1795|
|Meert, Kathleen; Telford, Russell; Holubkov, Richard et al. (2018) Paediatric in-hospital cardiac arrest: Factors associated with survival and neurobehavioural outcome one year later. Resuscitation 124:96-105|
|Cashen, Katherine; Reeder, Ron W; Shanti, Christina et al. (2018) Is therapeutic hypothermia during neonatal extracorporeal membrane oxygenation associated with intracranial hemorrhage? Perfusion 33:354-362|
|Slomine, Beth S; Silverstein, Faye S; Christensen, James R et al. (2018) Neurobehavioural outcomes in children after In-Hospital cardiac arrest. Resuscitation 124:80-89|
|Meert, Kathleen; Slomine, Beth S; Christensen, James R et al. (2018) Burden of caregiving after a child's in-hospital cardiac arrest. Resuscitation 127:44-50|
Showing the most recent 10 out of 77 publications