- 11 de diciembre de 2023
Article of interest - Neurodevelopmental outcomes in congenital heart disease: Usefulness of biomarkersof brain injury
New article of interest of the RICORS-SAMID network
Abstract
Introduction: At present, neurodevelopmental abnormalities are the most frequent type ofcomplication in school-aged children with congenital heart disease (CHD). We analysed theincidence of acute neurologic events (ANEs) in patients with operated CHD and the usefulnessof neuromarkers for the prediction of neurodevelopment outcomes.
Methods: Prospective observational study in infants with a prenatal diagnosis of CHD whounderwent cardiac surgery in the first year of life. We assessed the following variables:(1) serum biomarkers of brain injury (S100B, neuron-specific enolase) in cord blood andpreoperative blood samples; (2) clinical and laboratory data from the immediate postnataland perioperative periods; (3) treatments and complications; (4) neurodevelopment (Bayley-IIIscale) at age 2 years.
Results: The study included 84 infants with a prenatal diagnosis of CHD who underwent cardiacsurgery in the first year of life. Seventeen had univentricular heart, 20 left ventricular outflowobstruction and 10 genetic syndromes. The postoperative mortality was 5.9% (5/84) and 10.7%(9/84) patients experienced ANEs. The mean overall Bayley-III scores were within the normalrange, but 31% of patients had abnormal scores in the cognitive, motor or language domains.Patients with genetic syndromes, ANEs and univentricular heart had poorer neurodevelopmen-tal outcomes. Elevation of S100B in the immediate postoperative period was associated withpoorer scores.
Conclusions: Children with a history of cardiac surgery for CHD in the first year of life are at riskof adverse neurodevelopmental outcomes. Patients with genetic syndromes, ANEs or univen-tricular heart had poorer outcomes. Postoperative ANEs may contribute to poorer outcomes.Elevation of S100B levels in the postoperative period was associated with poorer neurodeve-lopmental outcomes at 2 years. Studies with larger samples and longer followups are neededto define the role of these biomarkers of brain injury in the prediction of neurodevelopmentaloutcomes in patients who undergo surgery for management of CHD.