Neurodevelopmental outcome related to cerebral risk factors in children after neonatal arterial switch operation

Protracted birth (PB), perinatal asphyxia (PA), intraventricular cerebral haemorrhage (IVH) evaluated by pre/peri/postoperative cranial ultrasound, clinical seizures (CS) and high levels of the neuron-specific enolase (NSE) prior to as well as immediately after and 4 and 24 h after CPB in 25 neonates (mean age 7 days) were defined as cerebral risk factors. Correlation analyses (Fisher's Exact Test, Pearson Coefficient) were performed to the results of formalized clinical neurological (CNS) and complete developmental score (CDS) including 7 subtests (Vienna developmental test, standard values defined normal 100 ± 10, mean ± SD) at mean age 3.7 ± 0.5 years.PB was found in 16%, PA 0%, IVH 48%, residual IVH at discharge 24%, CS prior to surgery 16%, CS > 24 h after CPB 12%. NSE, elevated prior to surgery (11.3 ± 4.5 ng/ml, mean ± SD), increased to peak values 4 h after CPB (17.3 ± 6.0) and individual peak values within 24 h after CPB (19.9-7.0). CNS was normal in 84%, 16% had strabism. CDS was normal in 88% (100 ± 8), motor score 96% (99 ± 6), visual perception 88% (100 ± 9), learning and memory 96% (102 ± 7), cognitive score 100% (101 ± 8), language 100% (99 ± 5), socioemotional score 100% (103 ± 7). Developmental scores did not differ significantly from normal children. None of the considered risk factors had significant influence on any outcome parameter (P > 0.1 in all).In our study, neurodevelopmental outcome was not found dependent on cerebral risk factors as elevated NSE indicative of neuronal cell damage, intraventricular haemorrhage, seizures or pre-/perinatal asphyxia. Rare incidence of reduced test results might have masked significant correlations.