The Burden of Stroke in Neonates Undergoing Congenital Heart Surgery: A Large Multicenter Analysis.

BACKGROUND

Stroke affects surgical decision making and outcomes of neonatal cardiac surgery(CHS). We sought to assess the burden of stroke in this population from a large multi-center database.

METHODS

We analyzed neonates undergoing CHS with cardiopulmonary bypass from the Pediatric Health Information System database(2004-2022). The cohort was divided into stroke-group which included pre/post-op ischemic, hemorrhagic-subtypes and grade III-IV intraventricular hemorrhages and compared in-hospital and follow-up outcomes to non-stroke group.

RESULTS

Of 14,228 neonates, 800(5.6%) had a peri-operative stroke. Stroke-group was more likely to have hypoplastic left-heart syndrome (HLHS)(30.5% vs 20.7%), born pre-term(19.4% vs 11.7%), low-birthweight(17.8% vs 11.9%) and require ECMO(48.8% vs 13.8%)(all, p<0.001). Outcomes comparing stroke vs no-stroke were, mortality:33.1% vs 8.9%, non-home discharge:12.5% vs 6.9%, length of stay:41 vs 24 days, hospitalization-costs:$354,521 vs $180,489(all, p<0.05). Stroke increased odds of mortality by two-fold[OR 2.20(1.75-2.77), p<0.001] after adjusting for ECMO, prematurity among other significant factors. On follow-up, stroke-group had higher incidence of hydrocephalus(9.5% vs 1.3%), cerebral palsy (6.2% vs 1.3%), autism spectrum disorder(7.1% vs 3.5%) and had higher one- and five- year mortality among survivors of index admission(5.3% and 11.3% vs 3.3% and 5.9%, respectively) (all p<0.05).

CONCLUSIONS

Neonatal CHS patients born prematurely, diagnosed with HLHS or those requiring ECMO are disproportionately affected by stroke. The occurrence of stroke is marked by significantly higher mortality. Future research should seek to identify factors leading to stroke, in order to increase rescue after stroke and for improvement of long-term outcomes.

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.