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Original Articles: Pediatric Cardiac

Near-Infrared Spectroscopy in Neonates Before Palliation of Hypoplastic Left Heart Syndrome

^a Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
^b Division of Cardiology, Medical College of Wisconsin, Milwaukee, Wisconsin
^c Division of Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin
^d Division of Neonatology, Medical College of Wisconsin, Milwaukee, Wisconsin
^e Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
^f Department of Anesthesia, Medical College of Wisconsin, Milwaukee, Wisconsin
^g Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin

Accepted for publication October 14, 2008.

^_* Address correspondence to Dr Ghanayem, Children's Hospital of Wisconsin, 9000 W Wisconsin Ave, Milwaukee, WI 53226 (Email: nancyg{at}mcw.edu).

Presented at the Forty-fourth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2008.

Background: Neonates with hypoplastic left heart syndrome have circulatory vulnerability that results in shock and high risk of mortality without intervention. High arterial saturation (SaO₂) is often used as a proxy for inadequate systemic oxygen delivery and triggers the use of invasive therapies to restore circulatory balance. We hypothesized that preoperative use of near-infrared spectroscopy (NIRS) would reduce the need for invasive therapies, including controlled ventilation and inspired gas manipulation.

Methods: A Human Research Review Board–approved retrospective review of patients who had stage 1 palliation from Januar 2000 to January 2006 was conducted. Preoperative patient characteristics, cardiorespiratory support, and monitored data were collected for all patients. Cerebral and somatic tissue oxyhemoglobin saturations were recorded for patients with preoperative NIRS monitoring.

Results: The studied cohort included 92 patients, 47 without and 45 with preoperative NIRS. Patient characteristics were similar between groups. Differences were observed in preoperative respiratory support. Controlled ventilation was less common in the NIRS group (51% versus 79%, p = 0.005) as was the use of inspired nitrogen (16% versus 70%, p = 0.001). The NIRS patients had higher mean SaO₂ (92% versus 88%, p = 0.001). Age at surgery was similar between groups (5.7 ± 3.2 versus 6.5 ± 5.2 days, p = 0.3). Early survival was 96% in each group.

Conclusions: Near-infrared spectroscopy monitoring of patients with hypoplastic left heart syndrome awaiting palliation provides noninvasive assessment of oxygen delivery and simplified management, with reduced use of controlled ventilation and inspired gas. Higher SaO₂ in the NIRS group was not associated with impaired systemic oxygen delivery, and did not lead to earlier palliation or postoperative mortality.