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.

Public Health Relevance

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.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Cooperative Clinical Research--Cooperative Agreements (U10)
Project #
Application #
Study Section
Special Emphasis Panel (ZHD1-DSR-A (25))
Program Officer
Maholmes, Valerie
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Children's Research Institute
United States
Zip Code
Moler, Frank W; Silverstein, Faye S; Holubkov, Richard et al. (2017) Therapeutic Hypothermia after In-Hospital Cardiac Arrest in Children. N Engl J Med 376:318-329
Cashen, Katherine; Reeder, Ron; Dalton, Heidi J et al. (2017) Functional Status of Neonatal and Pediatric Patients After Extracorporeal Membrane Oxygenation. Pediatr Crit Care Med 18:561-570
Heneghan, Julia A; Pollack, Murray M (2017) Morbidity: Changing the Outcome Paradigm for Pediatric Critical Care. Pediatr Clin North Am 64:1147-1165
Berger, John T; Villalobos, Michele E; Clark, Amy E et al. (2017) Cognitive Development 1 Year After Infantile Critical Pertussis. Pediatr Crit Care Med :
Slomine, Beth S; Nadkarni, Vinay M; Christensen, James R et al. (2017) Pediatric cardiac arrest due to drowning and other respiratory etiologies: Neurobehavioral outcomes in initially comatose children. Resuscitation 115:178-184
Newth, Christopher J L; Sward, Katherine A; Khemani, Robinder G et al. (2017) Variability in Usual Care Mechanical Ventilation for Pediatric Acute Respiratory Distress Syndrome: Time for a Decision Support Protocol? Pediatr Crit Care Med 18:e521-e529
Carcillo, Joseph A; Sward, Katherine; Halstead, E Scott et al. (2017) A Systemic Inflammation Mortality Risk Assessment Contingency Table for Severe Sepsis. Pediatr Crit Care Med 18:143-150
Carcillo, Joseph A; Halstead, E Scott; Hall, Mark W et al. (2017) Three Hypothetical Inflammation Pathobiology Phenotypes and Pediatric Sepsis-Induced Multiple Organ Failure Outcome. Pediatr Crit Care Med 18:513-523
Berger, John T; Holubkov, Richard; Reeder, Ron et al. (2017) Morbidity and mortality prediction in pediatric heart surgery: Physiological profiles and surgical complexity. J Thorac Cardiovasc Surg 154:620-628.e6
Moler, Frank W; Hutchison, Jamie S; Nadkarni, Vinay M et al. (2016) Targeted Temperature Management After Pediatric Cardiac Arrest Due To Drowning: Outcomes and Complications. Pediatr Crit Care Med 17:712-20

Showing the most recent 10 out of 63 publications