6102 Perioperative factors and their association with brain injury in neonates with complex congenital heart disease: a retrospective cohort study

Objectives Neonates with Complex Congenital Heart Diseases (CCHD) often necessitate early surgical intervention. Despite preoperative and postoperative care advancements, the risk of perioperative brain injury persists, with circulatory disturbances (periods of hypoxia and or ischemia) being a primary concern. Recognizing the role of different perioperative factors is essential to devise strategies that mitigate neurological complications and bolster neurodevelopmental outcomes. We aim to explore the correlation between perioperative factors and brain injuries in neonates diagnosed with CCHD. Methods This retrospective cohort study was conducted between 1 January 2018 and 31 March 2021 at Sidra Medicine's Level IV Neonatal Intensive Care Unit in Qatar. We included neonates (>36 weeks without genetic disorder) with CCHD who underwent perioperative Magnetic Resonance Imaging (MRI) brain scans. The study team collected pre-, intra-, and postoperative factors and reviewed the perioperative MRI brain images of study populations using the hospital's electronic medical record system. MRI-based Brain injury severity (BIS) was categorized for each subject. 0 for none or minimal injury (mild White Matter Injury (WMI)) and Intra-Ventricular Hemorrhage (IVH) grade I to II; no stroke); 1 for stroke (any size stroke without moderate-to-severe WMI); and 2 for moderate-to-severe injury (moderate and severe WMI). Results Throughout the study duration, 44 participants were enrolled, undergoing a total of 51 MRI scans. Preoperative MRI results showed that 86% had no brain injury, while 14% registered a BIS of 2. Conversely, postoperative MRI revealed that 57% were injury-free, 10% had a BIS of 1, and 33% had a BIS of 2. (table 1a, 1b, and 1c) Predominantly, babies with transposition of great arteries (32%) and single ventricle physiology (30%) were represented. Detailed demographic data and perioperative factors are elaborated in tables 2a and 2b. After univariate analysis (table 3), a multivariate analysis was done to identify the preoperative, intra-operative, and postoperative factors that influenced the likelihood of brain injuries, though not all were statistically significant except the preop factor (babies who received anti- epileptics for seizure) (OR 25) (p 0.02). Conclusion This study underscores the heightened risk of brain injuries, as evidenced in MRI imaging, among neonates with transpositions of great arteries and single ventricle physiology. Our findings emphasize the need for targeted interventions and monitoring for specific neonate subgroups undergoing surgeries for CCHD. References Peyvandi S, Xu D, Barkovich AJ, Gano D, Chau V, Reddy VM, Selvanathan T, Guo T, Gaynor JW, Seed M, Miller SP, McQuillen P. Declining Incidence of postoperative neonatal brain injury in congenital heart disease. J Am Coll Cardiol. 2023 Jan 24;81(3):253–266. doi: 10.1016/j.jacc.2022.10.029. PMID: 36653093. Neukomm A, Ehrler M, Feldmann M, Chaouch A, Knirsch W, Hagmann C, Jakab A, Latal B. Perioperative course and socioeconomic status predict long-term neurodevelopment better than perioperative conventional neuroimaging in children with congenital heart disease. J Pediatr. 2022 Dec;251:140–148.e3. PMID: 35948191. Peyvandi S, Chau V, Guo T, Xu D, Glass HC, Synnes A, Poskitt K, Barkovich AJ, Miller SP, McQuillen PS. Neonatal brain injury and timing of neurodevelopmental assessment in patients with congenital heart disease. J Am Coll Cardiol. 2018 May 8;71(18):1986–1996. PMID: 29724352; PMCID: PMC5940013.