PMID- 24203460
OWN - NLM
STAT- MEDLINE
DCOM- 20150401
LR  - 20211021
IS  - 1556-0961 (Electronic)
IS  - 1541-6933 (Linking)
VI  - 21
IP  - 1
DP  - 2014 Aug
TI  - Cerebral regional oxygen saturation and serum neuromarkers for the prediction of 
      adverse neurologic outcome in pediatric cardiac surgery.
PG  - 133-9
LID - 10.1007/s12028-013-9934-y [doi]
AB  - BACKGROUND: The aim of this study is to determine the utility of non-invasive 
      bedside neuromonitoring, including cerebral regional oxygen saturation (rSO2) 
      measured by near-infrared spectroscopy and serum biomarkers, in identifying 
      children at risk from adverse neurological outcome after heart surgery. METHODS: 
      Prospective observational study including 39 consecutive children undergoing 
      heart surgery with cardiopulmonary bypass (CPB) and normal neurologic exam prior 
      to surgery. Cerebral rSO2 was measured at baseline (prior to surgery) and then 
      continuously during surgery and for the first 16 h post-operatively. Neuromarkers 
      [neuron-specific enolase (NSE), S100beta, glial fibrillary acidic protein (GFAP), 
      and brain-derived neurotrophic factor (BDNF)] were measured in serum at baseline, 
      immediately after CPB and at 16 h post-operatively. Adverse neurological outcome 
      was defined as an abnormal pediatric cerebral performance category (PCPC) scale 
      score at 12 months after surgery. RESULTS: Sixteen children (41 %) had an 
      abnormal PCPC scale score at the 12-month evaluation after surgery. In children 
      with unfavorable neurological outcomes, mean cerebral rSO2 values were lower and 
      the area-under-the-curve below a threshold of 40 and 20% below baseline were also 
      increased. No significant differences were found in serum neuromarkers between 
      groups at the time points that were assessed. CONCLUSIONS: Bedside determination 
      of cerebral rSO2 may have some utility in identifying children at risk for 
      adverse neurological outcome after heart surgery in children. Additional studies 
      that are sufficiently powered to control for the many covariates in this patient 
      population will be required to fully interrogate this important question. The 
      role of serum neuromarkers in the immediate post-operative period do not appear 
      to be helpful in this question, though more thorough interrogation of delayed 
      periods may ultimately demonstrate some utility in answering this question.
FAU - Sanchez-de-Toledo, Joan
AU  - Sanchez-de-Toledo J
AD  - Pediatric Cardiac Intensive Care Unit, University of Pittsburgh, Pittsburgh, PA, 
      USA, joansdt@gmail.com.
FAU - Chrysostomou, Constantinos
AU  - Chrysostomou C
FAU - Munoz, Ricardo
AU  - Munoz R
FAU - Lichtenstein, Steve
AU  - Lichtenstein S
FAU - Sao-Aviles, Cesar A
AU  - Sao-Aviles CA
FAU - Wearden, Peter D
AU  - Wearden PD
FAU - Morell, Victor O
AU  - Morell VO
FAU - Clark, Robert S B
AU  - Clark RS
FAU - Toney, Nicole
AU  - Toney N
FAU - Bell, Michael J
AU  - Bell MJ
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Neurocrit Care
JT  - Neurocritical care
JID - 101156086
RN  - 0 (Biomarkers)
RN  - S88TT14065 (Oxygen)
SB  - IM
MH  - Biomarkers/blood
MH  - Brain/metabolism/*physiopathology
MH  - Cardiac Surgical Procedures/*adverse effects
MH  - Cardiopulmonary Bypass/*adverse effects
MH  - Humans
MH  - Infant
MH  - Intraoperative Neurophysiological Monitoring/methods
MH  - Neurophysiological Monitoring/*methods
MH  - Oximetry
MH  - Oxygen/metabolism
MH  - Postoperative Complications/*diagnosis
MH  - Prognosis
MH  - Spectroscopy, Near-Infrared
MH  - Treatment Outcome
EDAT- 2013/11/10 06:00
MHDA- 2015/04/02 06:00
CRDT- 2013/11/09 06:00
PHST- 2013/11/09 06:00 [entrez]
PHST- 2013/11/10 06:00 [pubmed]
PHST- 2015/04/02 06:00 [medline]
AID - 10.1007/s12028-013-9934-y [doi]
PST - ppublish
SO  - Neurocrit Care. 2014 Aug;21(1):133-9. doi: 10.1007/s12028-013-9934-y.