Hypothermia for cardiogenic encephalopathy in neonates with dextro-transposition of the great arteries. (22nd November 2020)

• Record Type: Journal Article
• Authors: Boos, Vinzenz; Bührer, Christoph; Photiadis, Joachim; Berger, Felix
• Is Part Of: Interactive cardiovascular and thoracic surgery. Volume 32:Number 1(2021)
• Page Start: 130
• Page End: 136
• Publication Date: 2020-11-22
• Subjects: Acidosis -- Congenital heart disease -- Encephalopathy -- Therapeutic hypothermia -- Transposition of the great arteries; Chest -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.1
• DOI: 10.1093/icvts/ivaa235
• Languages: English
• ISSNs: 1569-9293

Abstract

Abstract: OBJECTIVES: Neonates with dextro-transposition of the great arteries (d-TGA) may experience rapid haemodynamic deterioration and profound hypoxaemia after birth. We report on d-TGA patients with severe acidosis, encephalopathy and their treatment with systemic hypothermia. METHODS: This study is a single-centre retrospective cohort analysis of newborns with d-TGA. RESULTS: Ninety-five patients (gestational age ≥35 weeks) with d-TGA and intended arterial switch operation were included. Ten infants (10.5%) with umbilical arterial blood pH > 7.10 experienced profound acidosis (pH < 7.00) within the first 2 h of life. Six of these patients displayed signs of encephalopathy and received therapeutic hypothermia. Apgar scores at 5 min independently predicted the development of neonatal encephalopathy during postnatal transition (unit Odds Ratio 0.17, 95% confidence interval 0.06–0.49, P = 0.001). Infants treated with hypothermia had a more severe preoperative course and required more often mechanical ventilation (100% vs 35%, P = 0.003), treatment with inhaled nitric oxide (50% vs 2.4%, P = 0.002) and inotropic support (67% vs 3.5%, P < 0.001), as compared to non-acidotic controls. The median age at cardiac surgery was 12 (range 6–14) days in cooled infants and 8 (4–59) days in controls ( P = 0.088). Postoperative morbidity and total duration of hospitalization were not increased in infants receiving preoperative hypothermia. Mortality in newborns with severe preoperative acidosis was zero. CONCLUSIONS: Newborn infants with d-TGA have a substantial risk for profound acidosis during the first hours of life. Systemic hypothermia for encephalopathic patients may delay corrective surgery without compromising perioperative outcomes.