Neuromonitoring, neuroimaging, and neurodevelopmental follow-up practices in neonatal congenital heart disease: a European survey

Abstract

Background: Brain injury and neurodevelopmental impairment remain a concern in children with complex congenital heart disease (CHD). A practice guideline on neuromonitoring, neuroimaging, and neurodevelopmental follow-up in CHD patients undergoing cardiopulmonary bypass surgery is lacking. The aim of this survey was to systematically evaluate the current practice in centers across Europe.

Methods: An online-based structured survey was sent to pediatric cardiac surgical centers across Europe between April 2019 and June 2020. Results were summarized by descriptive statistics.

Results: Valid responses were received by 25 European centers, of which 23 completed the questionnaire to the last page. Near-infrared spectroscopy was the most commonly used neuromonitoring modality used in 64, 80, and 72% preoperatively, intraoperatively, and postoperatively, respectively. Neuroimaging was most commonly performed by means of cranial ultrasound in 96 and 84% preoperatively and postoperatively, respectively. Magnetic resonance imaging was obtained in 72 and 44% preoperatively and postoperatively, respectively, but was predominantly reserved for clinically symptomatic patients (preoperatively 67%, postoperatively 64%). Neurodevelopmental follow-up was implemented in 40% of centers and planned in 24%.

Conclusions: Heterogeneity in perioperative neuromonitoring and neuroimaging practice in CHD in centers across Europe is large. The need for neurodevelopmental follow-up has been recognized. A clear practice guideline is urgently needed.

Impact: There is large heterogeneity in neuromonitoring, neuroimaging, and neurodevelopmental follow-up practices among European centers caring for neonates with complex congenital heart disease. This study provides a systematic evaluation of the current neuromonitoring, neuroimaging, and neurodevelopmental follow-up practice in Europe. The results of this survey may serve as the basis for developing a clear practice guideline that could help to early detect and prevent neurological and neurodevelopmental sequelae in neonates with complex congenital heart disease.

Fig. 1

Map plot illustrating the distribution of the 25 European sites that provided a valid questionnaire response.

Fig. 2. Number of pediatric/neonatal cardiac surgeries.

Bar plot illustrating the distribution of yearly number of (a) pediatric and (b) neonatal cardiac surgeries at the responding centers.

Fig. 3. Use of pre- and postoperative neuromonitoring and neuroimaging tools.

Bar plot showing the percentages of preoperatively and postoperatively used neuromonitoring and neuroimaging tools. aEEG amplitude-integrated electroencephalography, NIRS near-infrared spectroscopy, EEG electroencephalography, CT computer tomography, CUS cranial ultrasound, MRI magnetic resonance imaging.

Fig. 4. Use of pre- and postoperative MRI.

Alluvial diagram illustrating the indication and mode of sedation/performance of preoperatively and postoperatively obtained cerebral magnetic resonance images (MRI). *As indicated: modality depends on the clinical condition.