Neonatal and 3-month cerebrovascular oxygenation, stability, and extraction in congenital heart disease versus control infants.

Objective: We compared indices for cerebrovascular health (i.e., physiological responses to tilts by measuring regional cerebral oxygenation [rcSO₂], cerebrovascular stability, and cerebral fractional tissue oxygen extraction [FTOE]) in infants with congenital heart disease (CHD) versus healthy controls (HC) at neonatal and 3-month ages.

Study design: Our cohort study included 101 neonates (52 CHD, 49 HC) and 108 infants at 3-months (45 CHD, 63 HC). We used an innovative and replicable evaluation tool to noninvasively and rapidly measure indices of cerebrovascular health. Changes in near infrared spectroscopy measures of rcSO₂ after tilting (from supine to sitting, ∼150 values) assessed cerebrovascular stability. Mixed-effects regression models examined rcSO₂ and FTOE differences between groups, and group-by-posture interactions, adjusting for postconceptional age, sex, ethnicity, and preductal systemic oxygenation (SpO₂) at both ages.

Results: Infants with CHD had significantly lower rcSO₂ (13% at neonatal and 11% at 3-months, both p < 0.001), increased FTOE (∼0.14 points higher at neonatal and ∼ 0.09 points at 3-months, both p < 0.001), and reduced cerebrovascular stability compared with HC at both ages (both p < 0.001).

Conclusions: CHD infants had persistently poorer indices of cerebrovascular health (i.e., lower rcSO₂, increased FTOE, and reduced cerebrovascular stability) through the 3-month age compared to controls. Sustained cerebral hypoxia, reduced cerebrovascular stability, and increased FTOE may contribute to neurodevelopmental delays (NDDs) and could serve as early biomarkers for identifying infants at higher risk for NDD.