Neurologic Status of Newborns With Congenital Heart Defects Before Open Heart Surgery

• Published in: Pediatrics (Evanston) Vol. 103; no. 2; pp. 402 - 408
• Main Authors: Limperopoulos, Catherine, Majnemer, Annette, Shevell, Michael I, Rosenblatt, Bernard, Rohlicek, Charles, Tchervenkov, Christo
• Format: Journal Article
• Language: English
• Published: Elk Grove Village, IL Am Acad Pediatrics 01-02-1999; American Academy of Pediatrics
• Subjects: Babies; Behavior; Biological and medical sciences; Birth defects; Cardiology. Vascular system; Cardiopulmonary bypass; Complications and side effects; Congenital heart defects; Congenital heart disease; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Heart; Heart Defects, Congenital - complications; Heart Defects, Congenital - surgery; Humans; Infant; Infant Nutritional Physiological Phenomena; Infant, Newborn; Infants (Newborn); Medical sciences; Nervous System Diseases - complications; Neurologic Examination; Neurologic manifestations; Neurologic manifestations of general diseases; Neurology; Newborn infants; Pediatrics; Physiological aspects; Prospective Studies; Psychological aspects; Respiration, Artificial; Sucking Behavior; Surgery; Canada; Human; Nervous system diseases; Newborn; Prevalence; Heart disease; Central nervous system disease; Cardiovascular disease; Exploration; Preoperative; Neurological disorder; Congenital disease
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.103.2.402

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.
To determine whether newborns with congenital heart defects demonstrate abnormalities in neurobehavioral status before surgery.
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.
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.
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.