Neurologic Status of Newborns With Congenital Heart Defects Before Open Heart Surgery
- 1 February 1999
- journal article
- Published by American Academy of Pediatrics (AAP) in Pediatrics
- Vol. 103 (2), 402-408
- https://doi.org/10.1542/peds.103.2.402
Abstract
Controversy exists regarding the integrity of the nervous system in the newborn with a congenital heart defect who must undergo corrective or palliative open heart surgery. Neurodevelopmental sequelae have been primarily attributed to surgical procedures without standardized evaluation of the preoperative neurologic status. Objective. To determine whether newborns with congenital heart defects demonstrate abnormalities in neurobehavioral status before surgery. Study Design. In this prospective study, a standardized neonatal neurobehavioral assessment and a neurologic examination were conducted independently in a consecutive series of 56 neonates referred to our hospital for investigation of open heart surgery. Results. Neurobehavioral and neurologic abnormalities were documented in greater than half of the cohort and included hypotonia, hypertonia, jitteriness, motor asymmetries, and absent suck. Poor state regulation (62%) and feeding difficulties (34%) also were commonly observed. Furthermore, 3 subjects had seizures, 35.7% were microcephalic, and 12.5% were macrocephalic. The overall likelihood of neurobehavioral abnormalities was not enhanced by indicators of cardiorespiratory compromise. Interestingly, newborns with acyanotic congenital heart defects were more likely to demonstrate neurologic compromise than were those with cyanotic defects. Conclusions. Findings suggest that the prevalence of neurobehavioral abnormalities before surgery in newborns with congenital heart defects has been underappreciated and would indicate that factors other than intraoperative procedures should be considered in the genesis of brain injury in this population.congenital heart defects, neurologic examination, newborn.Keywords
This publication has 20 references indexed in Scilit:
- High Incidence of Cranial Ultrasound Abnormalities in Full-Term Infants with Congenital Heart DiseaseAmerican Journal of Perinatology, 1996
- Prediction of outcome at school entry in neonatal intensive care unit survivors, with use of clinical and electrophysiologic techniquesThe Journal of Pediatrics, 1995
- Neurodevelopmental outcome of infants with hypoplastic left heart syndromeThe Journal of Pediatrics, 1995
- Influence of gestational age, birth weight, and asphyxia on neonatal neurobehavioral performancePediatric Neurology, 1993
- Improved neurological outcome following early anatomical correction of transposition of the great arteriesClinical Cardiology, 1992
- Neurological complications of open heart surgeryAnnals of Neurology, 1990
- A72 CEREBRAL AUTOREGULATION DURING CARDIOPULMONARY BYPASS IS TEMPERATURE DEPENDENT IN INFANTSAnesthesiology, 1990
- Interventions to reduce cerebral injury during cardiac surgery - the effect of physical and pharmacological agentsPerfusion, 1989
- Cognitive development in transposition of the great vessels.Archives of Disease in Childhood, 1988
- Developmental progress after cardiac surgery in infancy using hypothermia and circulatory arrest.Circulation, 1980