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Submitted: 21 July 2009
HERDIN Record #: PCHRD072009060752

A pre and post-operative evaluation of the neurologic status of children less than one year with cyanotic congenital heart disease at the Philippine Heart Center .

Rachelle Angeli R. Ninalga,
Magdalena J. Lagamayo,
Ma. Estrella Ibe-Ilustre

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Objective ÃÆ'Æ'Æ’ÃÆ'‚¢ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ To assess the neurologic status of children under one year with cyanotic congenital heart disease before and after cardiac surgery or intervention.

Design ÃÆ'Æ'Æ’ÃÆ'‚¢ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ Cohort Study

Methods ÃÆ'Æ'Æ’ÃÆ'‚¢ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ All patients included in the study were grouped according to their source of admission as elective/out-patient (group 1) and emergency/in-patient (group 2). All subjects in each group underwent thorough clinical neurological examinations and cranial unltrasonography (pre-operative screening). They were classified either as "without neurologic deficits" or "with neurologic deficits". The subjects in each group were followed up. The neurologic status of all subjects who underwent cardiac surgery and/or intervention was evaluated post-operatively. Statistical analysis included frequency measurements, analysis of variance and T-test.

Results ÃÆ'Æ'Æ’ÃÆ'‚¢ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ Group 1 had 16 patients while Group 2 had 9 patients who were subsequently admitted for intervention and/or surgery. The mean age in Group 1 and Group 2 was 5.5 months and 0.78 months, respectively. In Group 1, there were 7 females and 9 males while in Group 2, there were 2 females and 7 males. The mean oxygen saturation in Group 1 and 2 was 68% and 54%, respectively. There was a variety of cardiac lesions for Group 1 while 67% of Group 2 was mostly TGA. Pre-operative screening showed that 92% of the study population had normal neurologic examination (23 out of 25). One patient from Group 1, also a case of Down Syndrome, had hypotonia. Another patient from Group 2 had occasional secures pre-intervention due to hypoxia. Cranial ultrasound showed normal findings in 88% of the study population (22 out of 25). In Group 1, one patient had wide cavum septum pellucidum and another had slit-like ventricles, both with normal neurologic examination. One other patient from Group 2 had ventriculomegaly who had seizures pre-intervention. Pre-operative evaluation showed 2 patients having neurologic deficits, one from each Group. Twenty-three patients or 92 percent of the study population had no neurologic deficits. Out of the 9 patients in Group 2, 5 underwent intervention (BAS, PPBV). The remaining 6 underwent cardiac (5 open heart surgeries and 1 closed heart surgery). One patient who had no neurologic deficits pre-intervention developed seizures later post-BAS. Two patients went home with cerebral palsy. Four patients underwent open heart surgery with four mortalities. One patient was discharged improved post-ASO with no neurologic deficits. T-test showed that there was significant difference in the baseline oxygen saturation based on the nature of admission. Age and gender were not significant.

Conclusion ÃÆ'Æ'Æ’ÃÆ'‚¢ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ Majority of the patients included in this study showed normal baseline neurologic examination with normal cranial ultrasound findings. Significantly, the mean oxygen saturation of the patients in Group 2 was lower than that of Group 1. Due to the poor surgical outcome of the patients who underwent open heart surgery, the postoperative neurologic evaluation could not be properly assessed. Likewise, an adequate analysis on the predictors of adverse neurologic outcome of post-operative patients cannot be made. Hence, no conclusion can be derived from these.

Publication Type
Journal
Publication Sub Type
Journal Article, Original
Title
Philippine Heart Center Journal
Frequency
Others
Publication Date
January-March 2007
Volume
13
Issue
1
Page(s)
17-22

Objectives

Objective: To assess the neurologic status of children under one year with cyanotic congenital heart disease before and after cardiac surgery or intervention.

Specific Objectives:

1. To determine the patient characteristics of the study population such as age, sex, 02 saturation, clinical status and cardiac diagnosis and group them according to their source of admission, i.e., emergency (in-patient) or elective (out-patient).

2. To determine whether the subjects in each group demonstrate neurologic deficits before surgery or intervention based on clinical neurological examination and cranial ultrasonography.

3. To determine the outcome of the subjects in each group who underwent cardiac surgery or intervention

4. To determine whether the subjects in each group who underwent cardiac surgery or intervention demonstrate neurologic sequelae such as depressed sensorium, neurobehavioral abnormalities, seizures, involuntary
movements, cranial nerve deficits, motor and sensory deficits.

5. To identify the factors that enhance the risk for an adverse neurologic outcome including type or cardiac lesion, pre-existing neurologic abnormalities, ischemia time, level of hypothermia and prolonged bypass time among subjects who underwent open heart surgery.

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