Postoperative cerebral oxygen availability and neurodevelopment in children with d-transposition of the great arteries

Abstract

The etiology of neurodevelopmental impairments in children with d-transposition of the great arteries (TGA) is incomplete. We aimed to assess the association between postoperative cerebral oxygen availability and neurodevelopment in these children. Neonates with TGA and a ventricular septal defect (TGA-VSD, n = 11) or an intact ventricular septum (TGA-IVS, n = 19) and postmenstrual age-matched healthy controls (n = 19) underwent bedside optical neuromonitoring within 72 h post-surgery and 72 h post-birth, respectively. Indices of cerebral blood flow (CBFi) and oxygen delivery (CDO2i) were derived from neuromonitoring signals. 2-year neurodevelopmental outcome was evaluated using the Bayley Scales of Infant and Toddler Development 3rd/4th Ed. Neonates with TGA had lower CDO2i than controls. In children with TGA, lower postoperative CBFi and CDO2i were associated with lower motor composite, receptive communication and gross motor scores. When adjusted for sex and Bayley version, associations with receptive communication were stronger. In the TGA-IVS subgroup, CBFi and CDO2i were associated with all motor scales and most of these associations were stronger when adjusted. No associations were significant in the TGA-VSD subgroup. Although the modest cohort size and exploratory nature of subgroup results, postoperative CBFi and CDO2i may act as early biomarkers of brain maturity and future neurodevelopmental risk in children with TGA.