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 (CBF_i) and oxygen delivery (CDO_2i) 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 CDO_2i than controls. In children with TGA, lower postoperative CBF_i and CDO_2i 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, CBF_i and CDO_2i 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 CBF_i and CDO_2i may act as early biomarkers of brain maturity and future neurodevelopmental risk in children with TGA.