Claudia Benkwitz
Vanderbilt University, USA
Title: Neuromonitoring in the pediatric cardiac population – NIRS, an underutilized tool
Biography
Biography: Claudia Benkwitz
Abstract
Congenital heart disease (CHD) is the most common birth defect. Today, an increasing number of affected children, who not long ago were considered “inoperable” are now living into adulthood. In fact, there are now more adults than children living with CHD. This turning point has shifted the focus from “primarily survival” to “improving quality of life” for these patients. For this matter, a major area of concern is neurological morbidity, that affects 30-50% of children with CHD and is attributable to multiple causes. While vital organs are routinely monitored in the pediatric cardiac surgical setting, this typically does not hold true for the brain, where monitoring is still indirect. Yet, reliable and accurate neurological monitoring is essential to reduce the incidence of neurological complications and subsequent potential long-term cognitive dysfunction. In this discussion, we review various modalities of neuromonitoring for children undergoing congenital heart surgery with a focus on Near-Infrared Spectroscopy (NIRS). In addition, our own data will be presented, investigating a next generation NIRS device (FORE-SIGHT Elite Tissue oximeter) in combination with simultaneous vital sign recording in pediatric patients undergoing cardiac catheterization. Our data suggest that NIRS monitoring appears superior to standard vital sign monitoring when assessing “brain well-being”, thereby supporting routine use of NIRS as an independent monitor to achieve safer peri-OP management in this vulnerable and extremely heterogeneous patient population. Clearly, future studies refining efficacy and application of this technology are warranted and are on the way.