Abstract
Background: Neonates with transposition of the great arteries (TGA) are at risk of hypoxic-ischemic brain-injury. Balloon atrial septostomy (BAS) improves mixing of oxygen-saturated and -desaturated blood. We determined the impact of BAS on regional cerebral tissue oxygen saturation (rcSO2) and fractional cerebral tissue oxygen extraction (FTOE) in neonates with TGA.
Methods: Term neonates with TGA were included. RcSO2 was measured with near-infrared spectroscopy 2 hours (hrs) before, 2hrs after, and 24hrs after BAS for a two-hour period. Transcutaneous arterial oxygen saturation (tcSaO2) was measured simultaneously. FTOE was calculated: FTOE=(tcSaO2-rcSO2)/tcSaO2. In neonates who did not need BAS on clinical grounds, according to the attending cardiologist, tcSaO2 and rcSO2 were measured twice for a two-hour period: once within 24hrs after admission and once 24hrs later. Data were analysed by multi-level analysis and Mann-Whitney-U-test.
Results: Nine neonates (median age: 1 day [range:0-18]) underwent BAS and four neonates (median age: 4 days [range:0-6]) did not. RcSO2 increased after BAS (from mean 37% to 49% to 64% [p=0.000]), as did tcSaO2 (from mean 68% to 81% to 84% [p=0.000]). FTOE decreased after BAS (from mean 0.46 to 0.40 to 0.25 [p=0.000]). Neonates who did not need BAS showed higher baseline rcSO2 and tcSaO2 compared to neonates who did (median 57% vs 35% [p=0.020] and 88% vs 77% [p=0.034], respectively). After BAS, there were no differences between both groups.
Conclusion: In neonates with TGA in need of BAS, rcSO2 increased and FTOE decreased following BAS. This suggests improved cerebral oxygenation, which, possibly, protects against hypoxic-ischemic brain-injury.
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Van Der Laan, M., Verhagen, E., Kooi, E. et al. 221 Impact of Balloon Atrial Septostomy on Cerebral Oxygen Saturation and Oxygen Extraction in Neonates with Transposition of the Great Arteries. Pediatr Res 68 (Suppl 1), 115–116 (2010). https://doi.org/10.1203/00006450-201011001-00221
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DOI: https://doi.org/10.1203/00006450-201011001-00221