Prevalence of postoperative white matter injury has declined, correlating with increase in blood pressures after surgery
MONDAY, Feb. 6, 2023 (HealthDay News) — For neonates with complex congenital heart disease (CHD), the rates of postoperative white matter injury (WMI) have decreased over time, according to a study published in the January issue of the Journal of the American College of Cardiology.
Shabnam Peyvandi, M.D., from the University of California, San Francisco, Benioff Children’s Hospital, and colleagues prospectively enrolled 270 term newborns with complex CHD undergoing preoperative and postoperative brain magnetic resonance imaging (MRI) between 2001 and 2021. Brain injuries in the form of WMI or focal stroke and clinical factors were compared across four five-year intervals (epochs) using 466 MRI scans.
The researchers found that over time, there was no change in the rates of WMI and stroke. The odds of newly acquired WMI were significantly lower in epoch 4 versus 1 after adjustment for timing of the postoperative MRI, site, and cardiac group (odds ratio, 0.29). From epoch 1 to 4, there was a significant decline in the adjusted probability of postoperative WMI from 24 to 6 percent. In the most recent epoch, lowest systolic, mean, and diastolic blood pressures in the first 24 hours after surgery were significantly higher.
“We were surprised to find that advances in care over the past seven years resulted in a clear decline in brain injury linked to increasing the patient’s blood pressure following surgery,” Peyvandi said in a statement. “With advances in cardiac therapy and outcomes, our focus now is helping these children thrive.”