Association of Cerebral Oxygenation and Neurodevelopmental Outcomes After Neonatal Cardiac Surgery

Introduction: Congenital heart disease is estimated to effect 9 out of every 1000 livebirths worldwide, with roughly a quarter requiring intervention in early infancy. Despite medical and surgical advancement, neurodevelopmental outcomes have not improved substantially. Developmental delay remains a major morbidity following these surgeries. We sought to assess the prevalence of global developmental delay (GDD) at age 4 to 6 years in a cohort of patients who underwent neonatal cardiac surgery. Additionally, we sought to assess the relationship between cerebral regional oxygen saturation (crSO2) measures and subsequent diagnosis of GDD.


Methods: We included consecutive neonates ( < 30 d old) that underwent cardiac surgery with cardiopulmonary bypass over a 4-year period from October 2017 to September 2024 at our institution. We prospectively captured crSo2 values over the first 48 hours following surgery and averaged over 1-minute intervals. In addition to average crSo2 values, we calculated crSo2 desaturation indices defined as the duration of time over the first 48 hours following surgery where the crSo2 was below 55% (crSo2 DI-55%) or 50% (crSo2 DI-50%). Among patients who survived to at least 6 months of age, we performed a retrospective chart review to assess for GDD (median age at assessment 5.4 years, interquartile range 4.2 – 6.3 years).


Results: 175 neonates underwent cardiac surgery during this time, 162 survived to at least 6 months of age, and 126 were followed up. Of those who followed up, 52 had single ventricle physiology and 34 were diagnosed with global developmental delay (GDD). Patients with a diagnosis of GDD had lower average postoperative crSo2 (67% vs 74%, p= 0.004) and higher crSo2 DI-55% (209 vs 29 min, p< 0.001) and DI-50% (87 vs 2 min, p< 0.002). Adjusting for single ventricle physiology, both higher crSo2 DI-55% (p=0.019) and DI-50% (p=0.009) were associated with diagnosis of GDD.


Conclusions: Lower average postop crSO2 values and higher duration of time spent < 50-55% was associated with future diagnosis of GDD. Following neonatal cardiac surgery, crSO2 may be useful as an early prognostication adjunct for neurodevelopmental outcomes.