Postoperative Abdominal NIRS Values Predict Low Cardiac Output Syndrome in Neonates

Rhiannon L. Hickok, Michael C. Spaeder, John T. Berger, Jennifer Schuette, Darren Klugman

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The development of low cardiac output syndrome (LCOS) after cardiopulmonary bypass (CPB) occurs in up to 25% of neonates and is associated with increased morbidity. Invasive cardiac output monitors such as pulmonary artery catheters have limited availability and are costly. Near-infrared spectroscopy (NIRS) is a noninvasive tool for monitoring regional oxygenation in neonates in the cardiac intensive care unit (CICU). We hypothesize that anterior abdominal NIRS may aid in the early identification of LCOS after cardiac surgery.

METHODS: Prospective observational study from October 2013 to October 2014 of all neonates with congenital heart disease admitted to the CICU following CPB. Abdominal NIRS values were continuously recorded upon CICU admission and for the subsequent 24-hour period. The primary outcome was the development of LCOS. Low cardiac output syndrome was defined as the presence of metabolic lactic acidosis (pH < 7.3 and lactate > 4) or addition of a new vasoactive agent or a vasoactive inotropic score > 15. Autoregressive time series models were constructed for each patient based on the continuously recorded NIRS values, and patients were stratified by development of LCOS.

RESULTS: Twenty-seven neonates met inclusion criteria, of whom 11 developed LCOS. Neonates who developed LCOS had lower constant NIRS values (49% vs. 66%, P < .001). Constant NIRS values less than 58% best predicted development of LCOS with a sensitivity of 100% and specificity of 69%.

CONCLUSION: Lower constant anterior abdominal NIRS values in the early postoperative period may allow early identification of neonates at risk for LCOS.

Original languageEnglish (US)
Pages (from-to)180-184
Number of pages5
JournalWorld journal for pediatric & congenital heart surgery
Volume7
Issue number2
DOIs
StatePublished - Mar 1 2016
Externally publishedYes

Fingerprint

Low Cardiac Output
Near-Infrared Spectroscopy
Newborn Infant
Intensive Care Units
Cardiopulmonary Bypass
Lactic Acidosis
Acidosis
Postoperative Period
Cardiac Output
Pulmonary Artery
Thoracic Surgery
Observational Studies
Heart Diseases
Catheters
Prospective Studies
Morbidity
Sensitivity and Specificity

Keywords

  • congenital heart disease
  • congenital heart surgery
  • intensive care
  • neonate
  • postoperative care

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Postoperative Abdominal NIRS Values Predict Low Cardiac Output Syndrome in Neonates. / Hickok, Rhiannon L.; Spaeder, Michael C.; Berger, John T.; Schuette, Jennifer; Klugman, Darren.

In: World journal for pediatric & congenital heart surgery, Vol. 7, No. 2, 01.03.2016, p. 180-184.

Research output: Contribution to journalArticle

Hickok, Rhiannon L. ; Spaeder, Michael C. ; Berger, John T. ; Schuette, Jennifer ; Klugman, Darren. / Postoperative Abdominal NIRS Values Predict Low Cardiac Output Syndrome in Neonates. In: World journal for pediatric & congenital heart surgery. 2016 ; Vol. 7, No. 2. pp. 180-184.
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N2 - BACKGROUND: The development of low cardiac output syndrome (LCOS) after cardiopulmonary bypass (CPB) occurs in up to 25% of neonates and is associated with increased morbidity. Invasive cardiac output monitors such as pulmonary artery catheters have limited availability and are costly. Near-infrared spectroscopy (NIRS) is a noninvasive tool for monitoring regional oxygenation in neonates in the cardiac intensive care unit (CICU). We hypothesize that anterior abdominal NIRS may aid in the early identification of LCOS after cardiac surgery.METHODS: Prospective observational study from October 2013 to October 2014 of all neonates with congenital heart disease admitted to the CICU following CPB. Abdominal NIRS values were continuously recorded upon CICU admission and for the subsequent 24-hour period. The primary outcome was the development of LCOS. Low cardiac output syndrome was defined as the presence of metabolic lactic acidosis (pH < 7.3 and lactate > 4) or addition of a new vasoactive agent or a vasoactive inotropic score > 15. Autoregressive time series models were constructed for each patient based on the continuously recorded NIRS values, and patients were stratified by development of LCOS.RESULTS: Twenty-seven neonates met inclusion criteria, of whom 11 developed LCOS. Neonates who developed LCOS had lower constant NIRS values (49% vs. 66%, P < .001). Constant NIRS values less than 58% best predicted development of LCOS with a sensitivity of 100% and specificity of 69%.CONCLUSION: Lower constant anterior abdominal NIRS values in the early postoperative period may allow early identification of neonates at risk for LCOS.

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